Hypertension and cognitive function in the elderly.
Hypertension and cognitive function in the elderly.
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DOI：
10.1097/mjt.0b013e3180ed6b8f
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发表时间：
2007-11-01
影响因子：
4.2
通讯作者：
Senin, Umberto
中科院分区：
文献类型：
--
作者：
Cherubini, Antonio;Lowenthal, David T;Senin, Umberto
阿尔茨海默病是老年人中最普遍和常见的认知障碍形式，即痴呆，其次是血管性痴呆，由于与控制不良的高血压相关的微血管病。除了血压升高，年龄增长是痴呆症最大的危险因素。智力功能和认知技能的退化，导致老年患者越来越依赖于他/她的日常生活活动，即洗澡、穿衣、自我喂食、运动和个人卫生。多年来已知并证明，从先前的高血压点降低血压可导致中风预防，但降低血压不能预防导致白色物质脱髓鞘的微血管病，当与临床认知恶化结合时，其与血管性痴呆的诊断相符。从许多大型研究（如SHEP、SCOPE和HOPE）中可以看出，逐渐降低血压不会也不应该使认知障碍恶化。然而，如果压力不受控制，可能因此发生的中风将进一步恶化他们的认知障碍。因此，缓慢降低血压的尝试，因为随着年龄的增长，大脑自动调节较慢，这对患者最有利。同样重要的是要强调的是，控制血糖也可以被视为预防血管性痴呆的一种尝试，从不受控制的高血糖。血管性痴呆不被认为是痴呆的可逆原因之一。认知障碍的可逆原因是过度使用中枢作用药物，如镇静剂、催眠药、抗抑郁药和抗精神病药，电解质失衡，如低钠血症、氮质血症、慢性肝病和控制不良的慢性充血性心力衰竭。血管性痴呆的临床诊断标准包括关于先前功能性较高水平的认知下降，其特征在于记忆和两种或更多种高级上级皮质功能的改变，所述高级皮质功能包括定向、注意力、口头语言能力、视觉空间技能、计算、执行功能、运动控制、抽象和判断。意识障碍、谵妄（急性意识模糊状态）、精神病、严重失语症或妨碍正确执行神经心理测试的感觉运动改变的患者也被认为可能患有血管性痴呆。此外，这些是其他十种能够产生痴呆综合征的基本脑或系统性病理。
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.