Putting Fine Particulate Matter and Dementia in the Wider Context of Noncommunicable Disease: Where are We Now and What Should We Do Next: A Systematic Review.

INTRODUCTION: A significant proportion of the global population regularly experience air quality poorer than that recommended by the World Health Organization. Air pollution, especially fine particulate matter (PM2.5), is a risk factor for various noncommunicable diseases (NCDs) and is emerging as a risk factor for dementia. To begin to understand the full impact of PM2.5, we review the longitudinal epidemiological evidence linking PM2.5 to both dementia and to other leading NCDs and highlight the evidence gaps. Our objective was to systematically review the current epidemiological evidence for PM2.5 as a risk factor for cognitive decline and incident dementia and to put this in context with a systematic overview of PM2.5 as a potential risk factor in other leading NCDs. METHODS: We performed 2 systematic reviews. A high-level review of reviews examining the relationship between PM2.5 and leading NCDs and an in-depth review of the longitudinal epidemiological data examining relationships between PM2.5 incident dementia and cognitive decline. RESULTS: There were robust associations between PM2.5 and NCDs although in some cases the evidence was concentrated on short rather than longer term exposure. For those articles reporting on incident dementia, all reported on longer term exposure and 5 of the 7 eligible articles found PM2.5 to be associated with increased risk. CONCLUSION: The evidence base for PM2.5 as a risk factor for dementia is growing. It is not yet as strong as that for other NCDs. However, varied measurement/methodology hampers clarity across the field. We propose next steps.

Trajectory of blood pressure, body mass index, cholesterol and incident dementia: systematic review.

BACKGROUND: The global ageing population and the long prodromal period for the development of cognitive decline and dementia brings a need to understand the antecedents of both successful and impaired cognitive ageing. It is increasingly apparent that the trajectory of risk-factor change, as well as the level of the risk factor, may be associated with an increased or decreased risk of cognitive decline or dementia. AIMS: Our aim was to summarise the published evidence and to generate hypotheses related to risk-factor trajectories and risk of incident cognitive decline or dementia. METHOD: We collated data from longitudinal observational studies relating to trajectory of blood pressure, obesity and cholesterol and later cognitive decline or dementia using standard systematic review methodology. The databases MEDLINE, Embase and PsycINFO were searched from inception to 26 April 2018. RESULTS: Thirteen articles were retained for inclusion. Analytical methods varied. Our summary of the current evidence base suggests that first body mass index and then blood pressure rises and then falls more steeply in those who go on to develop dementia. The evidence for cholesterol was less consistent. CONCLUSION: Based on our review we present the hypothesis that weight falls around 10 years and blood pressure around 5 years before diagnosis. Confirmatory work is required. However, characterisation of risk according to combinations and patterns of risk factors may ultimately be integrated into the assessments used to identify those at risk of receiving a diagnosis of cognitive decline or dementia in late life.

Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort.

Aims: Systematically reviewing the literature found orthostatic hypotension (OH) to be associated with an increased risk of incident dementia but limited data were available in those at highest risk, the hypertensive oldest-old. Our aim was to analyse the relationship between OH and incident cognitive decline or dementia in this group and to synthesize the evidence base overall. Method and results: Participants aged ≥80 years, with hypertension, were from the Hypertension in the Very Elderly Trial (HYVET) cohort. Orthostatic hypotension was defined as a fall of ≥15 mmHg in systolic and or ≥7 mmHg in diastolic pressure after 2 min standing from a sitting position. Subclinical orthostatic hypotension with symptoms (SOH) was defined as a fall

Relationship Between Antihypertensive Medications and Cognitive Impairment: Part II. Review of Physiology and Animal Studies.

PURPOSE OF REVIEW: There is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer's disease; however, associations between antihypertensive medications (AHM) and dementia risk are less clear. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews provide comprehensive review. Our extensive review includes 24 mechanistic animal and human studies published over the last 5 years assessing relationship between AHM and cognitive function. RECENT FINDINGS: All classes of AHM showed similar result patterns in animal studies. The mechanism by which AHM exert their effect was extensively studied by evaluating well-established pathways of AD disease process, including amyloid beta (Aß), vascular, oxidative stress and inflammation pathways, but only few studies evaluated the blood pressure lowering effect on the AD disease process. Methodological limitations of the studies prevent comprehensive conclusions prior to further work evaluating AHM in animals and larger human observational studies, and selecting those with promising results for future RCTs.

Relationship Between Antihypertensive Medications and Cognitive Impairment: Part I. Review of Human Studies and Clinical Trials.

PURPOSE OF REVIEW: There is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer's disease; however, associations between antihypertensive medications (AHMs) and dementia risk are less consistent. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews are comprehensive. Our extensive review includes 15 observational and randomized controlled trials (RCTs) published over the last 5 years, assessing the relationship between AHM and cognitive impairment. RECENT FINDINGS: All classes of AHM showed similar result patterns in human studies with the majority of study results reporting point estimates below one and only a small number of studies (N = 15) reporting statistically significant results in favor of a specific class. Only a small number of studies reported statistically significant results in favor of a specific class of AHM. Methodological limitations of the studies prevent definitive conclusions. Further work is now needed to evaluate the class of AHM and cognitive outcomes in future RCTs, with a particular focus on the drugs with the promising results in both animals and human observational studies.

Is air pollution associated with increased risk of cognitive decline? A systematic review.

INTRODUCTION: exposure to air pollution has been shown to increase risk of inflammatory processes and risk of cardiovascular mortality. Such exposure may therefore also be a risk factor for cognitive impairment/dementia. METHOD: a systematic review of the literature was conducted with databases searched using keywords for air pollution, cognitive decline and dementia. All identified abstracts and potentially relevant articles were double read. For those papers meeting the inclusion criteria, summary tables were prepared and papers quality assessed. RESULTS: from 1,551 abstracts identified, 10 articles were retrieved of which two were rejected. Of the eight remaining six reported prevalent cognitive assessment with historical pollution exposure and two incident cognitive decline, also with historical pollution exposure. In general, an association was reported between exposure and poorer prevalent measures of cognitive function. Data were mixed for incident cognitive decline with one study finding an association and the other not. Reports were limited by a lack of detailed reporting, use of proxy measures of pollution exposure and a lack of clarity regarding cognitive testing methodology and analysis. CONCLUSION: this systematic review highlights that there is some evidence of a potential association between air pollution and subsequent cognitive decline. Further work is clearly required and longitudinal analysis of ongoing cohort studies or new research would add much needed clarity to this area.

Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review.

BACKGROUND: Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as a tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear. We undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps. METHODS: Medline, Embase and PsychInfo were searched from inception to the 28th Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927 RESULTS: Twenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes. DISCUSSION: Overall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.

The Kidney Evaluation and Awareness Program in Sheffield (KEAPS): a community-based screening for microalbuminuria in a British population.

BACKGROUND/OBJECTIVES: Microalbuminuria (MA) detects subjects at risk for cardiovascular disease (CVD) and chronic kidney disease (CKD) among diabetics, hypertensives and the general population. There is still a paucity of data on prevalence and risk factors for MA in the UK. We examined in a cross-sectional study, the prevalence and risk factors for MA in the general population of Sheffield, UK. METHODS: The study was conducted among participants of the Kidney Evaluation and Awareness Program in Sheffield (KEAPS), a population-based screening program for MA. The screening tools included a questionnaire collating information on demographics, lifestyle, medical and family history of diabetes mellitus, hypertension and CKD. MA measurements were obtained by immunonephelometry, and MA thresholds were defined using the albumin-creatinine ratio. RESULTS: The prevalence of MA was 7.1% in a random sample of a Sheffield-based population screened only once. The prevalence was 6.2% in the non-diabetic and non-hypertensive subjects. The prevalence of MA was only 1.3% in the subjects without any known risk factor, such as old age, diabetes, hypertension, obesity or CVD. The prevalence of MA could be overestimated as it was based on a single albumin-creatinine ratio testing. The independent predictor variables associated with the presence of MA in a mutually adjusted logistic regression model were: age (OR = 1.012, 95% CI: 1.00-1.02), diabetes (OR = 3.25, 95% CI: 1.30-8.13), obesity (OR = 4.09, 95% CI: 1.71-9.80) and family history of hypertension (OR = 1.87, 95% CI: 1.00-3.47). CONCLUSIONS: The main determinants of MA were increased age, diabetes, obesity and family history of hypertension. On the population level, obesity as a risk factor for MA is less well documented; in this study obesity had greater odds for MA than diabetes and hypertension.

Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis.

OBJECTIVE: High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data. METHODS: To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data. RESULTS: Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age. CONCLUSION: Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals. CLINICAL TRIALS REGISTRATION: The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

Health and use of health services: a comparison between Gypsies and Travellers and other ethnic groups.

OBJECTIVES: To examine the health status of adults from black and minority ethnic groups and from a socio-economically mixed White population, all resident in England. DESIGN: A cross-sectional questionnaire survey using validated standardised health measures of a sample of Gypsies and Travellers, Pakistani Muslims, African Caribbean, and White adults living in five geographical locations. Health outcomes included general health, health in the past year, limiting long-term illness, anxiety, depression, respiratory symptoms and angina. RESULTS: Of the 520 recruited age-sex matched sample (260 Gypsies and Travellers matched with 260 Pakistani Muslims, African Caribbean, and White residents), 516 were included in this analysis (173 men, 343 women). There were no differences by age between the four groups but men were approximately four years older than women. There were significant statistical differences in smoking status and educational attendance with more Gypsies and Travellers being current smokers (58% (95% confidence interval (CI) 52, 64) versus 25% (14, 38) or lower in the other groups) and having poorer regular educational attendance (61% (54, 68) versus 89% (77, 96) or higher in the other groups). For all health outcomes examined, Gypsies and Travellers had significantly poorer outcomes (after adjustment for age, sex and smoking status) compared with the White population. The health status of the Pakistani Muslims and African Caribbeans was similar to that of the Gypsies and Travellers for health in the past year, asthma, and depression, but other outcomes (cough, sputum) were significantly less prevalent. There were also significant differences in specific outcomes between African Caribbean and Pakistani Muslim populations. Consultations with various health professionals and use of health services varied between the groups. CONCLUSION: Being a Gypsy or Traveller is associated with even poorer health outcomes than those seen in two other ethnic minority groups resident in England, Pakistani Muslim and African Caribbean, and they in turn have poorer health outcomes than the White residents. More remains to be done to address the health and health service needs of such black and minority ethnic groups.

Air Pollution and Dementia: A Systematic Review.

BACKGROUND: Both air pollution and dementia are current and growing global issues. There are plausible links between exposure to specific air pollutants and dementia. OBJECTIVE: To systematically review the evidence base with respect to the relationship between air pollution and later cognitive decline and dementia. METHODS: Medline, Embase, and PsychINFO® were searched from their inception to September 2018, for publications reporting on longitudinal studies of exposure to air pollution and incident dementia or cognitive decline in adults. Studies reporting on exposure to tobacco smoke including passive smoking or on occupational exposure to pollutants were excluded. Using standard Cochrane methodology, two readers identified relevant abstracts, read full text publications, and extracted data into structured tables from relevant papers, as defined by inclusion and exclusion criteria. Papers were also assessed for validity. CRD42018094299Results:From 3,720 records, 13 papers were found to be relevant, with studies from the USA, Canada, Taiwan, Sweden, and the UK. Study follow-up ranged from one to 15 years. Pollutants examined included particulate matter ≤2.5 µ (PM2.5), nitrogen dioxide (NO2), nitrous oxides (NOx), carbon monoxide (CO), and ozone. Studies varied in their methodology, population selection, assessment of exposure to pollution, and method of cognitive testing. Greater exposure to PM2.5, NO2/NOx, and CO were all associated with increased risk of dementia. The evidence for air pollutant exposure and cognitive decline was more equivocal. CONCLUSION: Evidence is emerging that greater exposure to airborne pollutants is associated with increased risk of dementia.

Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia. DESIGN: A systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken. DATA SOURCES: Databases Medline, Embase and PsycINFO were searched from 1999 to 2017. ELIGIBILITY CRITERIA: For inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors. RESULTS: Seventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure. CONCLUSIONS: The strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is needed to establish whether particular combinations of risk factors confer greater risk than others. PROSPERO REGISTRATION NUMBER: 42016052914.

Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction.

Noncommunicable disease now contributes to the World Health Organization top 10 causes of death in low-, middle- and high-income countries. Particular examples include stroke, coronary heart disease, dementia and certain cancers. Research linking clinical and lifestyle risk factors to increased risk of noncommunicable disease is now well established with examples of confirmed risk factors, including smoking, physical inactivity, obesity and hypertension. However, despite a need to target our resources to achieve risk reduction, relatively little work has examined the overlap between the risk factors for these main noncommunicable diseases. Our high-level review draws together the evidence in this area. Using a systematic overview of reviews, we demonstrate the likely commonality of established risk factors having an impact on multiple noncommunicable disease outcomes. For example, systematic reviews of the evidence on physical inactivity and poor diet found each to be associated with increased risk of cancers, coronary heart disease, stroke, diabetes mellitus and dementia. We highlight the potential for targeted risk reduction to simultaneously impact multiple noncommunicable disease areas. These relationships now need to be further quantified to allow the most effective development of public health interventions in this area.

A population-based screening for microalbuminuria among relatives of CKD patients: the Kidney Evaluation and Awareness Program in Sheffield (KEAPS).

BACKGROUND: Microalbuminuria has been used to detect subjects at risk of cardiovascular disease and chronic kidney disease (CKD) in patients with diabetes, those with hypertension, and the general population. However, relatives of patients with CKD have not been investigated for microalbuminuria in the United Kingdom. STUDY DESIGN: A cross-sectional study evaluating the prevalence of microalbuminuria in relatives of patients with CKD compared with the general population of Sheffield, England. SETTING & PARTICIPANTS: Participants in the Kidney Evaluation and Awareness Program in Sheffield, a population-based screening program for microalbuminuria. 274 relatives of patients with CKD were studied and compared with an age- and sex-matched control group from the general population. PREDICTOR: Family history of CKD. MEASUREMENT & OUTCOMES: Screening tools included a questionnaire collating information for demographics, lifestyle, and medical and family history of diabetes, hypertension, and CKD. Urine samples were collected for microalbuminuria estimation. Microalbuminuria measurements were obtained by using immunonephelometry. Microalbuminuria thresholds were defined using albumin-creatinine ratio. RESULTS: The prevalence of microalbuminuria was 9.5% in those with a family history of CKD. This was significantly greater than the prevalence of 1.4% in the age- and sex-matched control group with no family history of CKD (P = 0.001). Independent determinants of microalbuminuria in the study population in an adjusted logistic regression model were family history of diabetes (odds ratio [OR], 2.88; 95% confidence interval, 1.17 to 7.04), obesity (OR, 3.29; 95% confidence interval, 1.61 to 6.69), and family history of CKD (OR, 6.96; 95% confidence interval, 3.48 to 13.92). LIMITATIONS: Cross-sectional snapshot analysis, microalbuminuria measured once. CONCLUSIONS: The prevalence of microalbuminuria in relatives of patients with CKD is greater than in an age- and sex-matched control group from the general population. The prognostic value of microalbuminuria in this category of at-risk population remains to be determined in longitudinal studies.

Alcohol, dementia and cognitive decline in the elderly: a systematic review.

BACKGROUND: dementia and cognitive decline have been linked to cardiovascular risk. Alcohol has known negative effects in large quantities but may be protective for the cardiovascular system in smaller amounts. Effect of alcohol intake may be greater in the elderly and may impact on cognition. METHODS: to evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and alcohol consumption, a systematic review and meta-analyses were carried out. Criteria for inclusion were longitudinal studies of subjects aged >or=65, with primary outcomes of incident dementia/cognitive decline. RESULTS: 23 studies were identified (20 epidemiological cohort, three retrospective matched case-control nested in a cohort). Meta-analyses suggest that small amounts of alcohol may be protective against dementia (random effects model, risk ratio [RR] 0.63; 95% CI 0.53-0.75) and Alzheimer's disease (RR 0.57; 0.44-0.74) but not for vascular dementia (RR 0.82; 0.50-1.35) or cognitive decline (RR 0.89; 0.67-1.17) However, studies varied, with differing lengths of follow up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders. CONCLUSIONS: because of the heterogeneity in the data these findings should be interpreted with caution. However, there is some evidence to suggest that limited alcohol intake in earlier adult life may be protective against incident dementia later.

Health status of Gypsies and Travellers in England.

OBJECTIVE: To provide the first valid and reliable estimate of the health status of Gypsies and Travellers in England by using standardised instruments to compare their health with that of a UK resident non-Traveller sample, drawn from different socioeconomic and ethnic groups, matched for age and sex. DESIGN: Epidemiological survey, by structured interview, of quota sample and concurrent age-sex-matched comparators. SETTING: The homes or alternative community settings of the participants at five study locations in England. PARTICIPANTS: Gypsies and Travellers of UK or Irish origin (n = 293) and an age-sex-matched comparison sample (n = 260); non-Gypsies or Travellers from rural communities, deprived inner-city White residents and ethnic minority populations. RESULTS: Gypsies and Travellers reported poorer health status for the last year, were significantly more likely to have a long-term illness, health problem or disability, which limits daily activities or work, had more problems with mobility, self-care, usual activities, pain or discomfort and anxiety or depression as assessed using the EuroQol-5D health utility measure, and a higher overall prevalence of reported chest pain, respiratory problems, arthritis, miscarriage and premature death of offspring. No inequality was reported in diabetes, stroke and cancer. CONCLUSIONS: Significant health inequalities exist between the Gypsy and Traveller population in England and their non-Gypsy counterparts, even when compared with other socially deprived or excluded groups, and with other ethnic minorities.

Health-related beliefs and experiences of Gypsies and Travellers: a qualitative study.

OBJECTIVE: To illuminate findings of the survey of the health status of Gypsies and Travellers by exploring their health-related beliefs and experiences. DESIGN: Qualitative study of a purposive subsample from in-depth interviews using framework analysis. SETTING: The homes or alternative community settings of the participants in five geographically dispersed study locations in England. PARTICIPANTS: 27 Gypsies and Travellers with an experience of ill health, purposively sampled from a larger population participating in an epidemiological survey of health status. RESULTS: The experience of poor health and daily encounters of ill health among extended family members were normalised and accepted. Four major themes emerged relating to health beliefs and the effect of lifestyle on health for these respondents: the travelling way; low expectations of health; self-reliance and staying in control; fatalism and fear of death. These themes dominated accounts of health experience and were relevant to the experience. These themes add richness to the health status data and inform our understanding. CONCLUSIONS: Among Gypsies and Travellers, coherent cultural beliefs and attitudes underpin health-related behaviour, and health experiences must be understood in this context. In this group, ill health is seen as normal, an inevitable consequence of adverse social experiences, and is stoically and fatalistically accepted. The provision of effective healthcare and improvement of poor health in Gypsies and Travellers will require multi-agency awareness of these issues.

Variation in prescribing for anxiety and depression: a reflection of health inequalities, cultural differences or variations in access to care?

BACKGROUND: There are large variations in mental health prescribing in UK populations. However the underlying reasons for these differences, which may be related to differences in prevalence, cultural expectations or practical difficulties in access to treatment, remain uncertain. METHODS: Linear modelling was used to investigate whether population characteristics or access to primary care account for variations in mental health prescribing across 39 deprived neighbourhoods. RESULTS: The proportion of sampled respondents whose first language was not English and the ratio of general practitioners to population explained 61% of variation. Deprivation and mental health status were not significant predictors of prescribing in these relatively deprived communities. CONCLUSION: These findings suggest that mental health prescribing, within deprived areas, as well as reflecting cultural and social differences in prescribing, may also be a proxy measure of access to care.

Potential for specific dihydropyridine calcium channel blockers to have a positive impact on cognitive function in humans: a systematic review.

BACKGROUND: There is some evidence to suggest a possible association between calcium channel blocker (CCB) use and a lower decline in cognitive function compared with use of other hypertensive treatments. In particular, there is an emerging interest in the potential for specific CCBs, particularly the dihydropyridine CCBs nitrendipine, nicardipine, cilnidipine, lercandipine, nimodipine, azelnidipine and nilvadipine. The aim of this review was to assess the evidence relating to these specific CCBs and incident cognitive decline or dementia in humans. METHODS: A systematic review of the literature was carried out. The databases MEDLINE, Embase and PsychINFO were searched from 1980 to 18 April 2014. All abstracts were reviewed by two independent reviewers. RESULTS: From 753 unique records, 16 full text articles were examined and three retained. The three articles reported data from two studies. A 12-week double-blind randomized controlled trial of nitrendipine compared with cilazapril and a longer and larger double-blind placebo-controlled trial also of nitrendipine, namely the Systolic Hypertension in Europe trial (SYST-EUR). Nitrendipine was associated with a reduction in incident dementia in the SYST-EUR trial. There was no association seen for cognitive outcomes in the smaller trial. CONCLUSION: At present there is limited evidence to suggest that nitrendipine may be associated with reduction in incident dementia. This association comes from a single trial and needs to be replicated. Furthermore, there is no high-quality evidence for any of the other potential candidate CCBs.

Heart enlargement after thrombolysis for unsuccessful resuscitation.

Thrombolysis has been recently reported for the treatment of unsuccessful out-of-hospital cardiopulmonary resuscitation. This case report presents the first case of mediastinal hematoma following thrombolysis in this setting. Chest X-ray and hemodynamic pattern mimicked pericardial effusion with cardiac-filling compromise. Diagnosis was established by transesophageal echocardiography and chest computerized tomodensitometry.