Gliomatosis cerebri presenting as rapidly progressive dementia and parkinsonism in an elderly woman: a case report.

Introduction: Dementia is one of the most important neurological disorders in the elderly. Dementia of tumoral origin is rare and parkinsonism of neoplastic origin is unusual. We herein report a case of gliomatosis cerebri, a very rare brain tumor seldom affecting the elderly, which presented as rapidly progressive dementia and parkinsonism.

Executive functions deficit in mild cognitive impairment.

Objective: To investigate whether patients diagnosed with amnestic mild cognitive impairment (MCI) have also impairment in attention/executive functions, and therefore to clarify whether all subcomponents of executive control are equally affected in MCI.

Background: MCI refers to the transitional state between normal aging and dementia. Amnestic MCI is characterized by impaired episodic memory, although subtle impairment of executive functions has been noted on neuropsychologic tests.

[What is the most relevant definition of orthostatic hypotension: systolic blood pressure drop, diastolic blood pressure drop, or both?].

Unlabelled: The agreed definition of orthostatic hypotension (OH) is a drop of 20 mmHg systolic and/or 10 mmHg diastolic blood pressure (BP) within the first 3 min of erect posture. For elderly people, a question can be raised about diastolic BP relevance in OH's definition.

Objective: To determinate HO's prevalence and risks factors considering systolic blood pressure (SBP)'s drop, or diastolic blood pressure (DBP)'s drop, or either.

[Relationship of white matter lesions on brain computed tomography and cognitive function in elderly subjects with mild cognitive impairment].

Unlabelled: White matter lesions (WML) are frequently disclosed on elderly people computed tomography (CT) brain scan.

Objective: To evaluate the relationship between WML and cognitive functions of patients suffering from Mild Cognitive Impairment (MCI).

Methods: We studied the association between WML on CT brain scan and cognitive functions in 136 consecutive elderly subjects attending a geriatric outpatient clinic, suffering from MCI.

Rationale, design and methods of the OSCAR study: observational study on cognitive function and systolic blood pressure reduction in hypertensive patients.

Data from several recent clinical trials have suggested a beneficial effect of antihypertensive medications on preservation of cognitive function. Eprosartan, an angiotensin type-1 receptor antagonist (ARA) with dual action on both pre- and postsynaptic angiotensin type 1 receptors, may be effective in the control of SBP and the prevention of cognitive decline. The OSCAR (Observational Study on Cognitive function And SBP Reduction) study is an international longitudinal observational study with a duration of 6 months intended to examine the impact of the ARA eprosartan on cognitive function (assessed using the Mini-Mental State Examination [MMSE]) and control of systolic blood pressure (SBP) in a large international population of hypertensive patients managed in a standard primary care setting.

Apolipoprotein E epsilon4 allele frequency in elderly depressed patients with and without cerebrovascular disease.

Late-onset depression (LOD) could be a very early manifestation of Alzheimer's disease (AD), although contradictory results have been reported. Cerebrovascular disease (CVD) may favor the development of LOD, and that the particular forms of vascular depression should be individualized. The Apolipoprotein E (ApoE) epsilon4 allele was shown to be a risk factor for AD.

Relevance of 10-min delayed recall in dementia screening.

Within the context of early diagnosis of Alzheimer's disease (AD), there is a growing interest in neuropsychological screening tests. Amongst these tests, we focused on the largely used Memory Impairment Screen (MIS). The objective of the present work was to show that adding a 10-min delayed recall to the MIS, improves the test psychometric characteristics in order to detect dementia in the earliest stages.

[Ageing of the arterial wall].

Several mechanisms are implicated in the arterial wall changes due to ageing: ageing, hypertension and atherosclerosis. Although the changes related to ageing (arteriosclerosis) have many factors in common with those induced by hypertension, they differ from those caused by atherosclerosis although commonly associated. Arteriosclerosis causes a diffuse increase of the rigidity of the large arteries by disease of the media, the main clinical manifestation of which is the increase in pulsed pressure.

Management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey I.

Aims: Here, the aim is to study the management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey I. Heart Failure (HF) is common in older people and associated with poor outcome.

Methods And Results: We compared clinical characteristics, treatment, and short-term outcomes in 2780 octogenarians (group A, median age 85 years) and in 7912 younger patients (group B, median age 69 years) enrolled in the Euro Heart Failure Survey I.

Management of heart failure in the elderly: recommendations from the French Society of Cardiology (SFC) and the French Society of Gerontology and Geriatrics (SFGG).

Heart failure, a frequent disease in the elderly, has a pejorative prognosis. Clinical diagnosis is complicated by atypical or difficult-to-interpret symptoms and by the concomitant presence of other diseases, particularly cognitive impairment, neurological disorders and diseases of the musculoskeletal system. Among the additional investigations, echocardiography remains underused.

[Assessement of home blood pressure with a monitor including MAM technology: comparison with the standard monitor].

Objectives: To compare two periods of three days of home blood pressure monitoring (HBPM) using two different monitors with one including MAM (microlife average mode) technology.

Methods: In 152 hypertensive subjects referred to hypertension specialists, a self-measurement of blood pressure was performed sequentially with an Omron M6 (arm cuff, A/A, BHS validation) or Microlife BP-3AC1 with the MAM technology. Each patient recorded home blood pressure during two periods of 3 days with 3 measures in the morning and 3 in the evening.

[Home blood pressure monitoring in addition to office blood pressure determination is useful in patients with systolic hypertension before their inclusion into a drug trial].

Objective: In patients with uncontrolled systolic hypertension, to estimate the value of home blood pressure monitoring in addition to office blood pressure for inclusion in a trial.

Methods: 80 patients with systolic hypertension, defined as SBP > or =140 mmHg and pulse pressure > or =60 mmHg, were treated for 4 weeks with a thiazide diuretic at usual dose (25 mg HCTZ or 1.5 mg indapamide or methyclothiazide 5 mg).

Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints.

Objective: To evaluate the relationship between antihypertensive treatments and cognitive function in elderly hypertensive patients with memory complaints.

Methods: The association between cognitive function and antihypertensive drug therapy was studied in 1241 hypertensive elderly patients with memory complaints attending a geriatric outpatient clinic. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and validated neuropsychological tests (Cognitive Efficiency Profile; CEP).

[Management of hypertension in the very elderly].

The prevalence of hypertension in persons aged 80 years or older is about 70%. Recent studies in this population show the benefits of antihypertensive therapy, especially for stroke prevention. Accurate determination of blood pressure requires the use of ambulatory measurement methods or self-measurement at home because the frequency of "white coat" hypertension increases with age.

Heart failure with preserved systolic function: a diagnostic algorithm for a pragmatic definition.

Heart failure is a major health problem which often concerns the elderly. Prevalence of heart failure with preserved systolic function is increasing and varies from 40 to 50%. In the literature, and in the large epidemiological studies, it is commonly designed with the term of "diastolic heart failure", even if a precise analysis of diastolic function is not performed.

Prevalence, awareness, treatment, and control of hypertension in the elderly: the Three City study.

Objective: To study management of hypertension in the elderly in a large population-based study and to evaluate the prevalence of hypertension and factors related to awareness, treatment, and control.

Design: The Three City study, a population-based study among 9693 non-institutionalized individuals aged 65 years and over.

Methods: Blood pressure was measured with an automated electronic device, and treatment assessed, during home interview.

[Systolic blood pressures are not comparable when home blood pressure is measured with a wrist or an arm validated monitor].

Objectives: To compare home blood pressure values obtained with two validated OMRON (wrist or arm) monitors used sequentially in the same subject.

Methods: In 265 hypertensive subjects referred to hypertension specialists, a self measurement of blood pressure was performed sequentially with an OMRON M4-I (arm cuff, A/A, BHS validation) or OMRON RX-I (wrist cuff, B/B, BHS validation). Each patient recorded home blood pressure during two periods of 4 days with 3 measures in the morning and 3 in the evening.

Relationship between arterial stiffness and cognitive function in elderly subjects with complaints of memory loss.

Background And Purpose: To evaluate the relationship between arterial stiffness and cognitive function in a population of elderly subjects reporting memory loss.

Methods: We studied the association between cognitive function and arterial stiffness in 308 consecutive elderly subjects attending a geriatric outpatient clinic reporting memory impairment. Subjects were classified into 4 categories according to neuropsychological evaluation: normal cognitive function, mild cognitive impairment (MCI), Alzheimer disease (AD), or vascular dementia (VaD).

Treatment of hypertension and prevention of dementia.

Because of the aging population, the frequency of dementia will dramatically increase in the coming years. Prevention of cognitive disorders and dementia has become a major public health challenge. High blood pressure is a major risk factor for cerebrovascular diseases and is also correlated closely with cognitive decline and dementia.

How to limit screening of patients for atheromatous renal artery stenosis in two-drug resistant hypertension?

Background: The DRASTIC model based on nine variables (age, gender, recent onset of hypertension, smoking status, body mass index (BMI), abdominal bruit, atherosclerosis, dyslipidemia and creatininemia) has been proposed to predict renal artery stenosis (RAS) occurrence.

Methods: In a prospective multicenter study, the clinical usefulness of the DRASTIC model was checked in 336 patients with two-drug resistant hypertension. RAS was excluded using at least color Doppler sonography.

Evolution of blood pressure in patients with Alzheimer's disease: a one year survey of a French Cohort (REAL.FR).

Objectives: To determine the evolution of blood pressure in patients with moderate Alzheimer's disease among a one year longitudinal survey and to evaluate the relationship between blood pressure and cognitive functions.

Methods: In 327 subjects selected from the French research program on Alzheimer's disease (REAL.FR), systolic and diastolic blood pressure (SBP, DBP) were measured at the time of inclusion (M0), after 6 months (M6) and after 12 months (M12).

[Cognitive functions and hypertension].

The prevention of cognitive disorders and dementia represents a major challenge in the coming years. Hypertension is one of the principal risk factors for cerebrovascular diseases and is also closely correlated with cognitive decline and dementia. Most longitudinal studies have shown that cognitive functioning is often inversely proportional to blood pressure values measured 15 or 20 years previously.

Diuretics for cardiovascular prevention in the elderly.

High blood pressure (BP) is a major risk factor for cardiovascular and cerebrovascular diseases in elderly subjects. Antihypertensive drugs have shown clinical benefit both in primary and secondary prevention of cardiovascular events. If BP lowering represents the major determinant of the effects conferred by the antihypertensive treatment for prevention, recent studies have suggested some differences between classes of antihypertensive drugs according to age.

Prevention of dementia: lessons from SYST-EUR and PROGRESS.

Hypertension is one of the principal risk factors for cerebrovascular diseases, closely correlated also with cognitive decline and dementia. Data from recent therapeutic trials (SYST-EUR, PROGRESS) open the way toward the prevention of dementia (vascular or Alzheimer's type) by antihypertensive treatments. The results of these two studies suggest different mechanisms of action of antihypertensive drugs in the prevention of cognitive decline.

[Heart failure, a disease of the elderly].

INCREASING PREVALENCE OF HOSPITALISATIONS AND MORTALITY: Heart failure represents a major public health problem. Indeed, the ageing of the population and the frequency of cardiovascular risk factors explain the considerable increase in the prevalence of heart failure over the past few years. SYSTOLIC FUNCTION IS USUALLY PRESERVED: The physiopathological features of cardiovascular ageing have resulted in the high prevalence of heart failure with preserved systolic function.