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Blood pressure circadian rhythm and prognosis of older subjects

with cognitive impairment

N. Nesti


, C. Lorenzi


, E. Mossello


, E. Giuliani


, M. Bulgaresi


, V. Caleri



M. Pieraccioli


, E. Tonon


, M.C. Cavallini


, D. Simoni


, C. Baroncini



M. Di Bari


, C.A. Biagini


, N. Marchionni


, A. Ungar




Research Unit of

Medicine of Ageing, Department of Experimental and Clinical Medicine,

University of Florence and Azienda Ospedaliero Universitaria Careggi,



Division of Geriatric Medicine, Azienda Unità Sanitaria Locale

3, Pistoia, Italy


The loss of physiological blood pressure (BP) drop

during nighttime (BP dipping) is associated with cardiovascular

mortality. Few data exists about prognostic meaning of BP dipping in

cognitively impaired older subjects. Aim of this study is to evaluate the

prognostic effect of BP values and dipping pattern in older subjects

with dementia or Mild Cognitive Impairment (MCI) referred to two

memory clinics.


All subjects underwent ambulatory blood pressure mon-

itoring (ABPM).

According to the rate of decline of systolic BP during nighttime

compared with daytime, circadian rhythm was defined as dipping (D,

10% or less), non dipping (ND, between

9% and 0), or reverse

dipping (RD, >0).


We included 185 patients (mean age 79, mean MMSE score

22,7, 72% with high BP). After a median follow-up time of 3 years,

survival was significantly shorter in subjects with RD (n = 49) in

comparisonwith ND (n = 79) (p = 0.002) and D (n = 57) (p = 0.021). The

association between RD and mortality risk increased with decreasing

levels of daytime systolic BP. In a multivariable Cox regression model,

mortality risk was independently associated both with daytime

SBP>144 mmHg (OR 3.04; 95%CI 1.26, 7.36) and with RD (=R 3.11;

95%CI 1.33, 7.28). Among 124 survivors, MMSE score change did not

differ significantly according to dipping status.

Key conclusions:

In cognitively impaired older subjects high BP and

inversion of physiological nighttime dipping were both associated

with mortality risk. The prognostic effect of RD was stronger in those

with lower daytime BP. These results might partly be explained by

autonomic failure.


Comparison of cognitive functioning in spousal dementia

caregivers with two demographically matched control groups:

results from the DeStress study

M. O

Sullivan, M.M. Pertl, S. Brennan, I.H. Robertson, B.A. Lawlor.

Neuro-Enhancement for Independent Lives (NEIL), Trinity College

Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland


Recent population studies indicate that informal caregiv-

ing is associated with better health and cognition, supporting the

healthy caregiver hypothesis. However, caring for a spouse with

dementia is recognised as a chronic stressor, which may negatively

impact cognition. Evidence supporting the stress-cognition link in

caregivers includes self-selecting reference groups, which may

outperform groups selected by other methods.


We compared cognitive function in 253 spousal dementia

caregivers with two demographically matched non-caregiving control

groups drawn from (1) a recent Irish population study and (2) a self-

selecting sample. Comparable cognitive measures in all groups

included global cognitive functioning, processing speed, reaction

time and verbal fluency. Analysis of covariance was employed to

control for demographics, medications and dementia risk factors such

as obesity, smoking and physical inactivity.


Caregivers outperformed control groups on processing speed

(p < .001 and .02 respectively) and reaction time (p < .001 and .04);

these differences were present despite more prevalent depressive

symptoms, stress, hypertension, and emotional problems in caregivers

(all p

s < .001). However, caregivers performed more poorly on verbal

fluency compared with the population control group (p < 0.01). When

depression was entered as a covariate in the analyses only the

association with verbal fluency was no longer significant.


Our results support the healthy caregiver hypothesis for

domain specific cognitive outcomes. However, spousal dementia

caregivers display a decrement in executive function associated with

greater depression.


Increased mortality and hospital readmission risk in patients with

dementia and a history of cardiovascular disease: results from a

nationwide registry linkage study

I.E. van de Vorst, I. Vaartjes, M.L. Bots, H.L. Koek.

University Medical

Center, Utrecht


To evaluate the impact of cardiovascular disease (CVD)

on mortality and risk of hospital readmission in patients with



A prospective hospital-based cohort of 59,194 patients

with dementia (admitted to a hospital or visiting a dayclinic) was

constructed from 2000 through 2010. Patients (38.7% men, mean age

81.4 years (SD 7.0)), were divided in those with and those without a

history of CVD (total CVD; coronary heart disease (CHD), heart failure

(HF), stroke, atrial fibrillation (AF) or other CVD). Absolute mortality

risks (ARs) were investigated and median survival times were

calculated using Kaplan-Meier curves. Hazard ratios (HRs) for

mortality and readmission (adjusted for age, sex, comorbidity) were

investigated using Cox analyses.


Three-year ARs were higher (45.1% versus 36.8%) and median

survival times were shorter (40.5 months, 95%CI 39.0

42.0 versus 50.0

months, 95%CI 48.7

51.3, p < 0.001) among patients visiting a day-

clinic with a history of CVD than in those without. Differences were

less pronounced for inpatients. Among dayclinic patients, a history of

CVD (HR for total CVD 1.25, 95%CI 1.19

1.32, HF 1.97, 95%CI 1.63


stroke 1.39, 95%CI 1.16

1.66, AF 1.19, 95%CI 1.02

1.39, and other CVD

1.14, 95%CI 1.04

1.25) increased three-year mortality risk. There were

no differences in mortality for inpatients with/without a history of

CVD. Risk for readmission was further increased in the presence of

CVD in both patients groups.


Mortality and readmission risks are significantly higher

in hospitalized dementia patients with a history of CVD than in those

without. This was most pronounced in dayclinic patients.


Delirium as a non-traumatic brain injury: older patients with

delirium have similar biomarker profiles to patients with isolated

traumatic brain injury

T.A. Jackson


, B. Shears


, J.M. Lord


, A. Belli


, J. Hazeldine




Institute of

Inflammation and Ageing, University of Birmingham, UK


Delirium is an acute, severe neuropsychiatric syndrome

associated with poor outcomes. Delirium is associated with a central

inflammatory response, usually due to a precipitating peripheral

inflammatory insult. However the pathophysiology remains poorly

understood. Traumatic brain injury (TBI) is also common, associated

with poor outcome. It mirrors delirium as it is associated with a

peripheral inflammatory response secondary to a precipitating central

inflammatory insult. As such investigating peripheral serum biomar-

kers of neuronal injury in both conditions may provide insights into

their pathophysiology.


Peripheral serum biomarkers of neuronal injury (S100



neurone specific enolase [NSE], eotaxin and glial fibrillary acidic

protein [GFAP]) were analysed by ELISA and multiplex. These were

then compared in patients with delirium and isolated TBI, and healthy

controls. Relationships between these biomarkers with delirium

outcome and motoric subtype were also explored.


Delirium (n = 62, age = 85.6 ± 0.8 yrs) and TBI (n = 8, age =

37.1 ± 3.41 yrs) were associated with significantly higher serum S100



NSE and GFAP compared with controls (all p < 0.05). There was no

Oral presentations / European Geriatric Medicine 7S1 (2016) S1