Hypertension and Cognitive Disorders.

Systemic hypertension is possibly the most important modifiable risk factor for the development of cognitive decline, both for mild cognitive impairment (MCI) and dementia. For effective blood pressure (BP) control, it requires proper assessment, using brachial, central, and ambulatory measurements, and monitoring with a focus on different BP parameters. Different BP parameters like pulse pressure, mean arterial pressure, BP variability, and circadian parameters, like nondippers and early morning surge, should be considered in the evaluation for the risk of cognitive decline due to hypertension in middle age and older adults.

Role of Peripheral and Central Insulin Resistance in Neuropsychiatric Disorders.

Insulin acts on different organs, including the brain, which helps it regulate energy metabolism. Insulin signaling plays an important role in the function of different cell types. In this review, we have summarized the key roles of insulin and insulin receptors in healthy brains and in different brain disorders.

Approach to the diagnosis and management of dysbiosis.

All microorganisms like bacteria, viruses and fungi that reside within a host environment are considered a microbiome. The number of bacteria almost equal that of human cells, however, the genome of these bacteria may be almost 100 times larger than the human genome. Every aspect of the physiology and health can be influenced by the microbiome living in various parts of our body.

Association between use of antihypertensives and cognitive decline in the elderly-A retrospective observational study.

Aim: Mild cognitive impairment (MCI) is the prodromal phase of dementia. The objective of this study was to determine whether specific antihypertensives were associated with conversion from MCI to dementia.

Methods: In this retrospective study, a chart review was conducted on 335 older adults seen at the University of Alberta Hospital, Kaye Edmonton Seniors Clinic who were diagnosed with MCI.

Predictors of Conversion to Dementia in Patients With Mild Cognitive Impairment: The Role of Low Body Temperature.

Background: Subjects with mild cognitive impairment (MCI) can progress to dementia. Studies have shown that neuropsychological tests, biological or radiological markers individually or in combination have helped to determine the risk of conversion from MCI to dementia. These techniques are complex and expensive, and clinical risk factors were not considered in these studies.

Telemonitoring and protocolized case management for hypertensive community dwelling older adults (TECHNOMED): a randomized controlled trial.

Background: Home blood pressure (BP) telemonitoring combined with case management leads to BP reductions in individuals with hypertension. However, its benefits are less clear in older (age ≥ 65 years) adults.

Methods: Twelve-month, open-label, randomized trial of community-dwelling older adults comparing the combination of home BP telemonitoring (HBPM) and pharmacist-led case management, vs.

Clinical electrophysiology of the aging heart.

Introduction: Advancements in medical and consumer-grade technologies have made it easier than ever to monitor a patient's heart rhythm and to diagnose arrhythmias. Octogenarians with symptomatic arrhythmias have unique management challenges due to their frailty, complex drug interactions, cognitive impairment, and competing comorbidities. The management decisions are further complicated by the lack of randomized evidence to guide treatment.

Microbial Therapeutics in Neurocognitive and Psychiatric Disorders.

Microbial therapeutics, which include gut biotics and fecal transplantation, are interventions designed to improve the gut microbiome. Gut biotics can be considered as the administration of direct microbial populations. The delivery of this can be done through live microbial flora, certain food like fiber, microbial products (metabolites and elements) obtained through the fermentation of food products, or as genetically engineered substances, that may have therapeutic benefit on different health disorders.

Holistic perspective of the role of gut microbes in diabetes mellitus and its management.

The gut microbiota (GM) plays a role in the development and progression of type 1 and type 2 diabetes mellitus (DM) and its complications. Gut dysbiosis contributes to the pathogenesis of DM. The GM has been shown to influence the efficacy of different antidiabetic medications.

Income disparity and incident cardiovascular disease in older Americans.

Objective: To examine the association between income and cardiovascular disease (CVD) in community-dwelling older adults.

Methods: Of the 5795 Medicare-eligible community-dwelling older Americans aged 65-100 years in the Cardiovascular Health Study (CHS), 4518 (78%) were free of baseline CVD, defined as heart failure, acute myocardial infarction, stroke, or peripheral arterial disease. Of them, 1846 (41%) had lower income, defined as a total annual household income <$16,000.

Gut microbes in neurocognitive and mental health disorders.

Introduction: As individuals age, the prevalence of neurocognitive and mental health disorders increases. Current biomedical treatments do not completely address the management of these conditions. Despite new pharmacological therapy the challenges of managing these diseases remain.

Utilization of computerized clinical decision support for potentially inappropriate medications.

Electronic medical record (EMR) alerts may inform point of care decisions, including the decision to prescribe potentially inappropriate medications (PIM) identified in the Beers criteria. EMR alerts may not be considered relevant or informative in the clinician context, leading to a phenomenon colloquially known as "alert fatigue." To assess the frequency of clinical interaction with EMR alerts and associated deprescribing behaviors in ambulatory settings.

Classic challenges and emerging approaches to medication therapy in older adults.

Prescribing medications safely and effectively in older adults is a complex process. This review discusses challenges with medication prescribing in older adults and outlines a holistic approach to medication management in older adults. Well-known challenges including the alterations in pharmacokinetics and pharmacodynamics that often occur with aging are discussed.

Role of Geriatric Syndromes in the Management of Atrial Fibrillation in Older Adults: A Narrative Review.

Objectives: Atrial fibrillation (AF) is common in older adults and associated with increased risk of cardiovascular events including thromboembolism. However, less is known about its association with noncardiovascular events, especially geriatric syndromes and conditions such as dementia, depression, impaired physical function, polypharmacy, falls, and poor quality of life. This review aims to help healthcare professionals integrate the special needs of older adults into their management of AF.

Cardiac rehabilitation and its effects on cognition in patients with coronary artery disease and heart failure.

Cardiac rehabilitation program is an evidence-based intervention and established model of exercise delivery following myocardial infarction and heart failure. Although it forms an important part of recovery and helps to prevent future events and complications, there has been little focus on its potential cognitive benefits. Areas covered: Coronary artery disease and heart failure are common heart problems associated with significant morbidity and mortality, and cognitive decline is commonly seen in affected individuals.

Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study.

Background: Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients.

Methods: We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living.

Comparison of the Assessment of Orthostatic Hypotension Using Peripheral and Central Blood Pressure Measurements.

Background: Orthostatic hypotension (OH) is associated with falls and cardiovascular events. There is growing evidence that central blood pressure (CBP) is better than peripheral blood pressure (PBP) in predicting adverse outcomes. The objectives of this study were to assess 1) the prevalence of OH identified using PBP and CBP and the levels of agreement, 2) the respective associations between OH and falls and cardiovascular comorbidities, by PBP and CBP, and 3) the association of OH with arterial wall stiffness markers (augmentation pressure (AP) and augmentation index (AI)).

Association between central blood pressure, arterial stiffness, and mild cognitive impairment.

Background: To determine the relationship between central blood pressure (CBP) indices and mild cognitive impairment (MCI) in adults over the age of 50.

Methods: A cross-sectional study conducted using a non-invasive SphygmoCor XCEL device. CBP indices and brachial blood pressure were measured in 50 inpatients and outpatients.

Comparison of two commonly used clinical cognitive screening tests to diagnose mild cognitive impairment in heart failure with the golden standard European Consortium Criteria.

Introduction: This study on mild cognitive impairment (MCI) in heart failure (HF) compares the utility of Montreal Cognitive Assessment (MoCA) to the Mini-Mental Status Exam (MMSE) for diagnosing MCI in a HF population when compared to the golden standard European Consortium Criteria (ECC).

Methods: Participants were recruited from the Alberta HEART study at the Mazankowski Alberta Heart Institute in Edmonton and St. Mary's hospital in Camrose.