Effect of Discontinuation of Antihypertensive Treatment in Elderly People on Cognitive Functioning—the DANTE Study Leiden

Influence of Small Vessel Disease and Microstructural Integrity on Neurocognitive Functioning in Older Individuals: The DANTE Study Leiden

“…15 Between June 2011 and August 2013, community-dwelling persons were included when they were 75 years of age or older, had a Mini Mental State Examination score between 21 and 27, were on antihypertensive medication, and had a current systolic blood pressure of Յ160 mm Hg. Excluded from the present study were participants with a clinical diagnosis of dementia, current angina pectoris, cardiac arrhythmia, heart failure, myocardial infarction, or a coronary reperfusion procedure Յ3 years ago and a history of stroke or transient ischemic attack.…”

“…A detailed description of the procedures used has been published previously. 15 The Medical Ethical Committee of the Leiden University Medical Center approved the study, and written informed consent was obtained from all participants.…”

“…Demographic characteristics were assessed at baseline by using a standardized interview, and blood pressure was measured. 15 General practitioners used structured questionnaires to obtain medical history and medication use. 17 segmented, 18 and aligned 3D T1 images into the Montreal Neurological Institute 152 standard space by using FLIRT.…”

“…21 A battery of cognitive tests was administered from which cognitive domain compound scores were calculated. 15 Executive function was assessed with the 25 These 6 tests were combined in the overall cognition com-pound score. The Geriatric Depression Scale (GDS)-15 26 was used to measure symptoms of depression (range, 0 -15 points, with higher scores indicating more symptoms), and the Apathy Scale of Starkstein,27 to measure symptoms of apathy (range, 0 -42 points, with higher scores indicating more symptoms).…”

Blood pressure evaluation and review of antihypertensive medication in patients with life limiting illness

“…A recent study, by Moonen and colleagues, has shown that discontinuing 108 antihypertensive medication in older people with mild cognitive deficits did not improve 109 cognitive, psychological or general daily functioning, although systolic and diastolic blood 110 pressures increased by and average of 7.36 and 2.63 respectively. [10] This is significant 111 progress, but given our work shows that antihypertensives are used inappropriately in patients 112 with life limiting illness, it would be prudent to focus future trials in this area to establish 113 evidence-based approaches to deprescribing medication. 114…”