title: Tolerability of ambulatory blood pressure monitoring (ABPM) in cognitively impaired elderly.
abstract: OBJECTIVE
  Recent guidelines have widened clinical indications for out-of-office blood pressure measurement, including home blood pressure monitoring and ambulatory blood pressure monitoring (ABPM), suggesting the latter as recommended method in cognitively impaired patients. There is, however, a widespread belief that ABPM could be poorly tolerated in dementia, often leading to withdraw from its use in these patients.
  
  
  OBJECTIVE
  To assess the actual tolerability of ABPM in a group of cognitively impaired elderly, affected by dementia or mild cognitive impairment (MCI).
  
  
  METHODS
  We evaluated 176 patients aged 65 + years, recruited in two different memory clinics, with a Mini Mental State Examination (MMSE) between 10 and 27. Behavioral and psychological symptoms were assessed with Neuropsychiatric Inventory (NPI). A patient was considered tolerant if able to keep the device on continuously for 24 h. The minimum number of correct measurements required was 70% of the predicted total number.
  
  
  RESULTS
  16% of patients wore the device for less than 24 h. Dividing the study population in tertiles of MMSE performance, 29% failed to tolerate the device in the lowest, 12% in the middle and 7% in the highest tertile (p < 0.01). Dividing the study population in tertiles of NPI performance, 30% of patients failed in the highest, 19% in the middle and 8% in the lowest tertile (p = 0.02); 31% of patients who tolerated the device did not achieve the minimum number of measurements required, with a mean number of 63% of predicted measurements.
  
  
  CONCLUSIONS
  The ABPM proved a generally well-tolerated technique even in cognitively impaired elderly. Only a minority of subjects with poorer cognitive performances and greater behavioral symptoms did not tolerate the monitoring. Among most patients who failed to achieve the minimum number of measurements needed, the number of valid measurements was very close to the minimum required.
authors.affiliation: Division of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nesti
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Pieraccioli
authors.forename: Enrico
authors.initials: E
authors.lastname: Mossello
authors.forename: Federica
authors.initials: F
authors.lastname: Sgrilli
authors.forename: Matteo
authors.initials: M
authors.lastname: Bulgaresi
authors.forename: Elena
authors.initials: E
authors.lastname: Crescioli
authors.forename: Francesco
authors.initials: F
authors.lastname: Biagini
authors.forename: Veronica
authors.initials: V
authors.lastname: Caleri
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tonon
authors.forename: Claudia
authors.initials: C
authors.lastname: Cantini
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Biagini
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Andrea
authors.initials: A
authors.lastname: Ungar
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis; D003704:Dementia / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008297:Male
keywords: Ambulatory blood pressure monitoring; dementia; elderly; hypertension; mild cognitive impairment