[Vascular dementia and systemic changes].
The aim of the study was to evaluate risk factors of atherosclerosis and extra-cerebral target organ damage in patients with hypertension and vascular based mild memory disorders. A group of the study included 20 persons at age of 54-75 (8 males and 12 females) with mild vascular dementia (20-25 pts in MMSE, 22.8 +/- 1.73) with treated mild hypertension. A diagnosis of vascular dementia was confirmed in MRI by two independent experts. All examined patients presented multiinfarction changes in central nervous system as a cause of dementia. The study protocol contained present history, physical examination, 24-hour ambulatory blood pressure monitoring (ABPM), ECG, biochemical tests: total cholesterol, HDL-Ch, LDL-Ch, triglycerides, glucose, urea, creatinine plasma levels and urine test for microalbuminuria. In part of the study group (55%) echocardiography with posterior wall (PW) thickness and ejection fraction (EF) evaluation was performed. In the analysed group mean 24-hour blood pressure values were not elevated (SBP 130.8 +/- 15.8 mm Hg and DBP 77.6 +/- 9.2 mm Hg at day, respectively 121.6 +/- 17.1 mm Hg and 68.2 +/- 11.6 mm Hg at night). No significant (> 10%) nocturnal SBP decrease was observed, however DBP fall was noticed. Either total cholesterol (n < 5.2 mmol/l) or LDL-Ch (n < 3.5 mmol/l) plasma levels were increased in patients with vascular dementia and ranged respectively 5.8 +/- 0.9 and 3.7 +/- 0.9 mmol/l, HDL-Ch and triglycerides levels remained normal (respectively 1.7 +/- 0.5 and 1.5 +/- 1.1 mmol/l). Mean urea and creatinine levels were maintained in normal range (urea 5.8 +/- 1.7 mmol/l, creatinine 75.5 +/- 15.1 mumol/l). In a part of study group (35%) microalbuminuria was presented (urine albumine > 20 mg/l). In majority of patients with hypertension and vascular dementia a few risk factors co-existed. No systolic blood pressure decrease observed at night in 24-hour blood pressure monitoring, though normal mean values, can play an important role in vascular abnormalities progression.
Katedra Chorób Wewnetrznych i Gerontologii Collegium Medicum Uniwersytetu Jagiellońskiego, 31-531 Kraków, ul. Sniadeckich 10. ala_klich@poczta.onet.pl
Alicja
A
Klich-Raczka
Mirosław
M
Necki
Barbara
B
Wizner
Tomasz
T
Baron
Agata
A
Adamkiewicz-Piejko
Barbara
B
Gryglewska
Tomasz
T
Grodzicki
D000368:Aged; D001921:Brain / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D015140:Dementia, Vascular / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index