Hypertension and cognitive function in the elderly

Alzheimer's disease is the most prevalent and common form of cognitive impairment, ie, dementia, in the elderly followed in second place by vascular dementia due to the microangiopathy associated with poorly-controlled hypertension. Besides blood pressure elevation, advancing age is the strongest risk factor for dementia. Deterioration of intellectual function and cognitive skills that leads to the elderly patient becoming more and more dependent in his, her, activities of daily living, ie, bathing, dressing, feeding self, locomotion, and personal hygiene. It has been known and demonstrated for many years that lowering of blood pressure from a previous hypertensive point can result in stroke prevention yet lowering of blood pressure does not prevent the microangiopathy that leads to white matter demyelinization which when combined with the clinical cognitive deterioration is compatible with a diagnosis of vascular dementia. It is known from many large studies, ie, SHEP, SCOPE, and HOPE, that lowering of blood pressure gradually will not and should not worsen the cognitive impairment. However, if the pressure is uncontrolled a stroke which might consequently occur would further worsen their cognitive derangement. So an attempt at slow reduction of blood pressure since cerebral autoregulation is slower as age increases is in the patient's best interest. It is also important to stress that control of blood glucose can also be seen as an attempt to prevent vascular dementia from uncontrolled hyperglycemia. Vascular dementia is not considered one of the reversible causes of dementia. Reversible causes of cognitive impairment are over medication with centrally acting drugs such as sedatives, hypnotics, antidepressants, and antipsychotics, electrolyte imbalance such as hyponatremia, azotemia, chronic liver disease, and poor controlled chronic congestive heart failure. Criteria for the clinical diagnosis of vascular dementia include cognitive decline in regards to preceding functionally higher level characterized by alterations in memory and in two or more superior cortical functions that include orientation, attention, verbal linguistic capacities, visual spacial skills, calculation, executive functioning, motor control, abstraction and judgment. Patients with disturbances of consciousness, delirium (acute confusional states), psychosis, serious aphasia, or sensory-motor alterations that preclude proper execution of neuro-psychological testing are also considered to have probably vascular dementia. Furthermore, these are ten of the other essential cerebral or systematic pathologies present that would be able to produce a dementia syndrome.     

Assessing cognitive functioning of the elderly with the ''Inventory of Piaget''s Developmental Tasks''

The purpose of this study was to examine the reliability, validity, and utility of the 'Inventory of Piaget's Developmental Tasks' (IPDT) with elderly persons. The IPDT is a paper-pencil assessment of levels of cognitive functioning. Seventy elderly adults responded to a battery of instruments. Reliability and validity estimates for the IPDT were acceptable. Data indicated that the IPDT has promise as a clinical assessment of cognitive functioning. Implications for patient teaching by nurses is discussed and suggestions for clinical use are made.     

Delirium in elderly patients: an overview of the state of the science

Delirium is a common and potentially preventable and reversible cause of functional disability, morbidity, mortality, and increased health care use among elderly individuals. Much has been learned about delirium in the past decade. Highlighted in this article are recent advances in the diagnosis of delirium, delirium in long-term care, use of health care resources, outcomes of delirium, etiologies, and interventions to prevent and treat delirium. Suggestions for future research also are proposed.     

Colour perception among the very elderly related to visual and cognitive function

Colour perception was studied among a representative sample of 95-year olds and compared with previously examined 80-year olds and a group with Alzheimer's disease (AD), mean age of 80 years. The 95-year olds' results were on a significantly lower level than the other two groups but showed a similar pattern as to colour -discrimination, -naming, -preferences and colour/form recognition. Visual function among 95-year olds had only minor influence on their result in contrast to cognitive function which had a more profound impact. Most interestingly though, the subjects with Alzheimer's diagnosis, younger than the 95-year olds but with a conclusive diagnosis of dementia, performed on an overall higher level than the 95-year olds. This advantage for the Alzheimer group remained even when compared with a sub sample of the 95-year olds with possible dementia diagnosis excluded. On the other hand, only including 95-year olds with a Mini Mental Examination score of >26 in comparison with the Alzheimer group made the differences between the two groups disappear. It is suggested that colour perception as measured in this study is well preserved throughout life. The overall lower colour perception ability in 95-year olds compared with both 80-year olds and subjects with AD may be an expression of the complexity of very high age rather than any isolated concomitant factor.     

Hypertension in the elderly

This article summarizes current recommendations for work-up and treatment of hypertension in elderly persons. The prevalence of hypertension in older persons is over 50 percent. A review of randomized controlled studies among older persons shows that treatment of hypertension reduces the risk of cardiovascular complications by about 30 to 50 percent. Since the absolute risk of cardiovascular disease at any given level of blood pressure in the elderly is three to four times greater than that in younger people, the potential benefit of antihypertensive treatment among older people is high. On the other hand, the potential risks of antihypertensive therapy need to be taken into account. The patients' other risk factors, pre-existing cardiovascular disease, and competing comorbid illnesses should be considered for treatment decisions. Baseline and follow-up control for detection of postural hypotension is emphasized.     

Hypertension in the elderly

Recent studies have indicated the need to modify criteria for the diagnosis of hypertension in the elderly. This audit uses computerised records to identify the population at risk and suggests that elderly hypertensives may now be overdiagnosed and overtreated.     

Hypertension in the elderly

Hypertension is predictive of a wide variety of subsequent adverse events in elderly patients, at least up to the age of 80 years. Treatment can reduce these adverse outcomes, although the benefits in the very elderly remain somewhat unclear. In the very elderly, there appears to be a reduction in cardiovascular events, but this reduction is perhaps at the expense of an increase in overall mortality. Target BPs in the elderly remain controversial. Among patients who have not had previous stroke or significant cardiovascular or renal disease, the benefits of reducing the SBP below 159 mm Hg are well documented. There is some evidence to suggest, however, that if doing so increases the day-night difference in BP by more than 20% or is associated with a decline in DBP below 65 mm Hg, then the benefits of treatment may be attenuated or lost. In addition, there is some suggestion that reducing SBP consistently below 135 mm Hg may accelerate cognitive decline. There appears to be a role for sodium restriction in those who can comply without otherwise compromising nutrient intake. Likewise, exercise may be beneficial and have benefits beyond simply lowering BP. Weight loss in those who are overweight may also help in lowering the BP. For most patients, low-dose thiazides such as hydrochlorothiazide are likely to be the appropriate first-line therapy (even in patients who have diabetes) unless they exacerbate or precipitate urinary incontinence or gout or complicate concomitant drug therapy (eg, lithium treatment of bipolar disorder). In very elderly patients, the apparent beneficial effects on strokes, major cardiovascular events, and heart failure rates may justify treating despite lack of benefit on overall mortality.     

Mild cognitive impairment in Hispanic Americans: an overview of the state of the science

The identification of persons with mild cognitive impairment (MCI) is becoming a priority in healthcare as persons with this disorder are generally believed to progress to a diagnosis of dementia or Alzheimer's disease (AD) at a higher rate than those persons without it in the general population. Despite the knowledge that minority groups, particularly Hispanics, have been shown to have an increased risk for the development of AD, there is paucity of research in the identification and progression of MCI in ethnic minority groups. This article will review MCI definitions, diagnostic criteria, and gaps that exist in the literature pertaining to MCI in Hispanic Americans. Central questions to be addressed by nurse scientists are given.     

Hypertension in the elderly

There is no doubt that hypertension is of importance to the health of the elderly, in terms of both mortality and disability. There is mounting evidence that antihypertensive therapy is effective in reducing target organ disease. More data are needed to arrive at optimal treatment regimens and to examine the efficacy of therapy in pure systolic hypertension. A stepped care, cautious approach to therapy should prove to be safe and beneficial.     

Hypertension in the elderly

Hypertension in the elderly is a consequence of several aging processes, and it is important to understand characteristics of elderly hypertension for diagnosis and treatment. Hypertension in the elderly is characterized by isolated systolic hypertension and increased pulse pressure in response to aortic stiffness. Decline in barorelfex, left ventricular hypertrophy, and impaired control of body fluid volume also need to be considered in the treatment of elderly hypertension, as these alternations may result in reduced tissue circulation and blood flow reserve. Target blood pressure of the elderly is < 140/90 mmHg, as suggested by the results of recent mega-trials. It is necessary to gradually decrease blood pressure in the elderly, as they might have reduced tissue circulation and impaired auto-regulation of blood flow.     

Hypertension in the elderly

As many as forty percent of Canadians over age sixty-five have blood pressure readings of 160/90 or higher. They are at greater risk for stroke, congestive heart failure, myocardial infarction and sudden death. Hypertension appears to be an exaggeration of the normal circulatory changes of aging--increased systemic vascular resistance and a slight decrease in cardiac output at rest and during exercise. The major trials of treatment for hypertension have included subsets of elderly hypertensives who have enjoyed about the same overall benefit from treatment as younger subjects. Two treatment trials specifically for elderly hypertensives also show that treating systolic-diastolic hypertension does more good than harm. Isolated systolic hypertension appears to be a risk factor of equal magnitude to systolic/diastolic hypertension. Although it is possible to treat isolated systolic hypertension, the definitive clinical trial comparing mortality and morbidity in treated and untreated groups is not yet published. Thiazides, while inexpensive and effective antihypertensives for the elderly, are relatively contraindicated in as many as half. Other classes of drugs, particularly calcium channel blockers, can be effective alternatives. Many, if not most, elderly hypertensives will be prescribed more than one type of antihypertensive in addition to other types of drugs. The possibility of drug interactions as well as the danger of overly rapid blood pressure reduction must be kept in mind.     

Hypertension in the elderly

Hypertension in the elderly may be of the classical or isolated systolic type. The former is amenable to therapy, and reduction in blood pressure clearly decreases morbidity and mortality. Isolated systolic hypertension is an undesirable risk factor, but the effectiveness of antihypertensive therapy for the problem is as yet unknown. Although various physiologic parameters change with age, diuretics, methyldopa, and beta-adrenergic blockers are generally safe in the elderly and are recommended.     

Hypertension in the elderly

Successful control of blood pressure through drug therapy can reduce morbidity and mortality in the elderly population. However, age-related factors also make this group prone to adverse side effects. A cautious approach is therefore recommended in the effort to achieve ideal control of blood pressure.