Relation of arterial stiffness with postural control in older people.

PURPOSE: Arterial stiffness generates vascular alterations that may cause balance disorders and falls. This study aimed to investigate the possible link between arterial stiffness and postural control under different sensorial conditions in patients over 65 years. METHODS: Carotid-femoral pulse wave velocity (PWV) was measured in 47 participants aged over 65 years to evaluate their arterial stiffness (high PWV). Twenty-seven participants (mean age = 70.52 ± 4.02 years, 22 females) had a normal PWV (< 10 m s-1) and 20 participants (mean age = 75.93 ± 6.11 years; 15 females) had a high PWV (≥ 10 m s-1). Postural control was evaluated using a force platform in four postural conditions: eyes open (EO) 1, eyes closed (EC), eyes open with a dual task (DT) and eyes open again (EO2). Using sway path traveled and surface covered by the center of foot pressure, we calculate the length function of surface (LFS). This ratio provides information about the precision (surface) of postural control and the effort made (length) by the subjects. RESULTS: After an age-adjustment, LFS was lower in EO than in EC and DT in both groups (p ≤ 0.001). LFS was higher in participants with high PWV both in eyes open and eyes closed conditions (p < 0.05). LFS increased when PWV increased in EO (p < 0.01) and EC conditions (p < 0.001) but not when a dual task was performed. CONCLUSION: Difficulties in maintaining equilibrium under a dual-task condition are more pronounced in people with increased arterial stiffness. These data suggest that understanding of the influence of the arterial stiffness level on specific balance control parameters could contribute to propose better balance-oriented rehabilitation programs in older adults in an attempt to prevent fall.

Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia.

BACKGROUND: The use of potentially inappropriate medications (PIMs) is an important issue in older patients who are at risk of adverse drug events. AIM: To determine the prevalence of PIM use, according to Beers criteria, among an older population (aged ≥65 years) in a large family medicine setting, and to identify the associated risks. DESIGN & SETTING: A prospective cross-sectional study of patients aged ≥65 years was conducted from June 2017 to June 2018 at the Family and Community Medicine (FCM) clinics of King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. METHOD: This cross-sectional study included patients aged ≥65 years who were seen at new appointments or followed-up at the FCM clinics of KSMC in Riyadh, Saudi Arabia. Data were collected by extensive face-to-face interviews and from the patients' medical records. RESULTS: A total of 270 older patients aged 72.41 ±6.23 years (mean ±standard deviation [SD]) were included in the present study. The prevalence of PIMs was 60.7% (n = 164). Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] 1.47, 95% confidence intervals [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95, 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21, 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPI), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use. CONCLUSION: This study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIM use. The frequency of morbidities was not significantly different among patients with PIMs compared to those without PIMs, except for hypertension and osteoarthritis, which were more common in the PIMs group. The present study reinforces the importance of comprehensive medication management and reviews.

Memory Alterations and White Matter Hyperintensities in Elderly Patients With Hypertension: The ADELAHYDE-2 Study.

OBJECTIVES: The longitudinal ADELAHYDE-2 study aims to identify the factors associated with cognitive impairment/decline and white matter hyperintensities burden. METHODS: Longitudinal single-center study comprising two visits separated by approximately 7 years. A total of 131 patients completed the two visits. The primary outcome was global memory composite scale, while the secondary outcome was white matter hyperintensities (WMH/Fazekas scale) load. RESULTS: Global memory at visit 2 (V2) was largely influenced by age, smoking status, glycated hemoglobin, and history of stroke already present at visit 1 (V1). These variables accounted for ∼51% of the memory alterations at V2. WMH at V2 was likely influenced by age, left ventricular hypertrophy, diabetes mellitus, carotid intima-media thickness, and body mass index at V1. These findings accounted for ∼37% of the WMH changes at V2. Increase in pulse wave velocity from V1 to V2 showed a trend for association with memory deterioration (adjusted estimates = 0.06; P = .067), whereas smoking and increase in systolic blood pressure (trend) were associated with an increment in WMH (adjusted estimates = 0.49; P = .047 and adjusted estimates = 0.01; P = .08, respectively). On the other hand, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and statins (trend) were likely to be protective (adjusted estimates for angiotensin-converting enzyme inhibitor/angiotensin receptor blockers = -0.49; P = .049, and adjusted estimates for statins = -0.46; P = .055). CONCLUSIONS: Several readily identifiable factors are associated with memory deterioration and WMH, many of which are potentially modifiable. Interventions aimed to control these risk factors need to be tested prospectively in order to assess their cognitive protective value.

Do Arterial Hemodynamic Parameters Predict Cognitive Decline Over a Period of 2 Years in Individuals Older Than 80 Years Living in Nursing Homes? The PARTAGE Study.

OBJECTIVES: Several studies have highlighted a link between vascular alterations and cognitive decline. The PARTAGE study showed that arterial stiffness as evaluated by carotid-femoral pulse wave velocity (cfPWV) was associated with a more pronounced cognitive decline over a 1-year period in very old frail institutionalized individuals. The aim of the present analysis was to assess the role of hemodynamic parameters, such as blood pressure (BP), heart rate (HR), cfPWV, and central/peripheral pulse pressure amplification (PPA) on cognitive decline over 2 years in very old frail individuals. METHODS: A total of 682 individuals from the PARTAGE study cohort, aged older than 80 years (mean age at inclusion: 87.5 ± 5.0 years) and living in French and Italian nursing homes, were analyzed. Mini-Mental State Examination (MMSE) score was assessed at baseline (BL) and at the end of the first and second year of follow-up (2y-FU). Those with a decrease in MMSE of 3 or more points between BL and 2y-FU were considered as "decliners." The cfPWV and PPA at baseline were assessed with an arterial tonometer. RESULTS: After adjustment for baseline MMSE, HR, body mass index, age, education level, and activities of daily living (ADLs), cfPWV was higher and PPA lower in "decliners" compared with "nondecliners," whereas BP did not differ between the 2 groups. Logistic multivariate analysis also revealed that high cfPWV, low PPA, high HR, and low ADLs were all determinants of MMSE decline. CONCLUSION: This 2-year longitudinal study in very old institutionalized individuals shows that arterial stiffness and high HR enabled us to identify subjects at higher risk of cognitive decline, whereas BP alone did not appear to have a significant predictive value. These findings highlight the contribution of vascular determinants in cognitive decline even in this very old population.

Complementarity of visual and voxel-based FDG-PET analysis to detect MCI-like hypometabolic pattern in elderly patients with hypertension and isolated memory complaints.

BACKGROUND: 18F-FDG PET can be used to aid in the diagnosis of Alzheimer's disease (AD) and clarify the diagnosis and prognosis of patients with mild cognitive impairment (MCI). PURPOSE: To compare the results of a quantitative analysis of FDG-PET brain images to a standard visual analysis (SVA) with regards to the detection of MCI-like hypometabolic pattern in elderly patients with hypertension and subjective, isolated memory complaints. MATERIAL AND METHODS: FDG-PET brain was performed in 71 patients (mean age, 76.4 ± 5.1 years; women, 53.5%). Images were analyzed for the presence of an MCI-like hypometabolic pattern using an SVA by 2 physicians and a voxel-based statistical procedure (statistical parametric mapping [SPM]) that compared each patient's images to normal reference samples from 19 elderly individuals obtained using the same PET camera. The reliability of these analyses was evaluated according to neuropsychological assessment results, including the Grober & Buschke Free and Cued Selective Reminding Test, and a combined analysis by a neuropsychologist. RESULTS: An MCI-like hypometabolic pattern was documented in 5 patients (7%) by SVA and 7 patients (10%) by SPM analysis; however, only 2 of these patients were selected by both methods. The group characteristics of the 7 patients identified by the quantitative method were consistent with the MCI pattern, which included a higher rate of abnormal GB-FCSRT in Free Recall (57% vs. 9%, p < 0.05) or in Total Recall (29% vs. 8%, p < 0.05) when compared with other patients. In contrast, the group identified by SVA did not exhibit these characteristics. CONCLUSION: A combined visual and quantitative analysis improves the diagnostic accuracy to detect an MCI-like hypometabolic pattern in elderly patients with hypertension and subjective, isolated memory complaints.

Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

Elderly Algerian women lose their sex-advantage in terms of arterial stiffness and cardiovascular profile.

OBJECTIVES: Several studies have shown lower carotid-femoral pulse wave velocity (cfPWV) levels in women compared to men, a difference that could partially explain the increased longevity in women. However, these studies have been performed in industrial countries while few data are available in emerging populations. We studied arterial stiffness, as evaluated by cfPWV, in elderly Algerian men and women. METHODS: cfPWV was studied in 321 Algerian men (81.2 ±â€Š5.3 years) and women (81.1 ±â€Š4.4 years). An age-matched and sex-matched cohort of European individuals (n = 321) was used as a control group. RESULTS: Comparatively to men, Algerian women exhibited higher BMI and heart rate (HR), higher prevalence of hypertension, and were more frequently treated for hypertension. cfPWV was not different between Algerian men (14.8 ±â€Š3.3 m/s) and women (14.9 ±â€Š3.4 m/s). By contrast, in Europeans, women had lower cfPWV (12.7 ±â€Š2.7 m/s) than men (14.0 ±â€Š3.3 m/s; P <0.001). Comparatively to European women, Algerian women had a higher cfPWV (P <0.01). In both ethnic groups, multivariate analyses revealed that age, mean blood pressure (BP), HR, and diabetes were positively associated with cfPWV, whereas female sex was associated with lower cfPWV only in Europeans. CONCLUSION: Elderly Algerian women exhibit arterial stiffness similar to men, whereas European women display lower arterial stiffness than men. This loss of 'arterial sex advantage' in Algerians may be explained by higher BP, HR, and a worse metabolic profile in Algerian women. Interventions in emerging populations, especially in women, should be a priority in order to address these risk factors by acting on current lifestyle.

Pulse wave velocity is associated with 1-year cognitive decline in the elderly older than 80 years: the PARTAGE study.

OBJECTIVES: Studies have shown the importance of vascular risk factors in the pathogenesis and evolution of cognitive disorders and dementia especially among the very elderly. The aim of the present longitudinal 1-year cohort analysis was to evaluate the influence of arterial stiffness on cognitive decline in institutionalized subjects older than 80 years. DESIGN: Longitudinal study. SETTING: Nursing homes in France and Italy. PARTICIPANTS: A total of 873 subjects (79% women), aged 87 ± 5 years were included in this longitudinal analysis from the PARTAGE cohort. MEASUREMENTS: All completed the Mini-Mental Status Examination (MMSE) on the 2 visits over 1 year and underwent a measurement of carotid-femoral pulse wave velocity (PWV), an indicator of aortic stiffness. Clinical and 3-day self-measurements of blood pressure (BP) and activities of daily living (ADL) were evaluated at baseline visit. RESULTS: According to PWV tertiles and after adjustment for baseline MMSE, mean BP (MBP), age, education level, and ADL, Δ MMSE was -1.42 ± 3.60 in the first tertile, -1.78 ± 4.08 in the second tertile, and -2.20 ± 3.98 in the third tertile (P < .03). Similar analyses with self-measured MBP failed to show any association between BP on MMSE decline. CONCLUSION: This 1-year longitudinal study in institutionalized patients older than 80 years shows that the higher the aortic stiffness, the more pronounced the decline in cognitive function. These results point out the interest of measuring PWV, a simple noninvasive and validated method for arterial stiffness assessment, to detect high-risk patients for cognitive decline.

Association study of gene polymorphisms involved in vascular alterations in elderly hypertensives with subjective memory complaints.

BACKGROUND: We have recently shown that vascular abnormalities are associated with cognitive impairment as well as with white matter hyperintensities (WMH) in elderly hypertensive patients presenting with subjective memory complaints (SMC), a population at high risk of developing dementia. The aim of the present study was to identify genetic variants associated with the degree of cognitive impairment and the severity of WMH in the same study population, focusing on genes involved in vascular alterations. METHODS: 50 gene polymorphisms known to be associated with vascular alterations (blood pressure regulation, lipid and homocysteine metabolism, thrombosis and inflammation) were genotyped using a multilocus genotyping assay in 369 elderly treated hypertensive patients >60 years of age and presenting with SMC but no dementia. The patients underwent a combination of neuropsychological tests and brain magnetic resonance imaging with semiquantification of WMH. RESULTS: None of the tested polymorphisms were found to be associated with age- and gender-adjusted memory score, visual capacity, body-mass-index-adjusted verbal fluency score or the age-adjusted WMH Fazekas score. CONCLUSION: Our results suggest that the associations between arterial factors and cognitive decline or WMH are not genetically driven by the genes we investigated, at least at this early stage of cognitive decline.

Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints.

BACKGROUND: Hypertension is strongly associated with cognitive decline and a promising target for dementia prevention. Our aim was to investigate the association between different antihypertensive treatments and cognitive performance in elderly hypertensive patients presenting with subjective memory complaints. PATIENTS AND METHODS: Three hundred and seventy-eight elderly hypertensive patients more than 60 years (mean age 70.4 ± 6.3 years) treated with at least one antihypertensive agent and presenting with subjective memory complaints but without dementia were prospectively recruited and underwent a combination of neuropsychological tests, brain magnetic resonance imaging with semiquantification of white matter hyperintensities, carotid echotracking, brachial endothelial function, and ambulatory blood pressure assessments. RESULTS: None of the three composite scores (memory score, verbal fluency, and visual memory capacity) was found associated with blood pressure levels. On the other hand, age-adjusted and sex-adjusted analyses showed a significant and positive association between memory score and use of calcium channel blockers (CCBs) (users: +0.14 ± 0.09 versus nonusers: -0.12 ± 0.06; P = 0.016). Multivariate analyses also revealed that CCB use was significantly associated with a better memory score, independently of age, male sex, white matter hyperintensities, and carotid wall cross-sectional area, all of which were associated with worse memory scores. CONCLUSION: In elderly hypertensive treated patients with subjective memory complaints, CCB use was associated with better memory performance independently of blood pressure level and macrovascular and microvascular alterations, suggesting a specific neuroprotective effect of this pharmacological class. Interventional controlled trials are required to confirm the specific protective effect of CCBs on cognitive decline.