Study of Vascular Causes of Cognitive Dysfunction in Geriatric Patients

Title: Study of Vascular Causes of Cognitive Dysfunction in Geriatric Patients

Authors: Dr Shishir Pandey, Dr Nimisha Mishra, Dr Anurag Churasia, Dr Pradeep Kumar

DOI: http://dx.doi.org/10.18535/jmscr/v4i9.87

Abstract

Introduction: Prevalence of cognitive dysfunction in patient attending the hospital is remarkably higher (31.53%) than in general population (3.5%).Many, often treatable, cognitive dysfunction cases are taken complacently and, either not identified or, ignored being attributed to aging process.

Objectives: (1) To unravel the vascular causes of cognitive dysfunction in geriatric patient and to correlate its clinical picture.

(2)To find out pattern of stroke, hypertension and cardic causes of cognitive dysfunction.

Material and Method: Total 1077 patient screened out of which 175 patients fulfill the criteria of age above 65 years with clinical evidence of cognitive dysfunction and scoring of <24 on MMSE are included in study, diagnostic categorization, routine and special investigation were conducted out in each patient.

Result: Major vascular causes of cognitive dysfunction are stroke ,hypertension, and cardic respectively out of which stroke caused cognitive dysfunction in 33% of cases, hypertension in 19% cases, cardic disease caused cognitive dysfunction in 15% of cases.

Conclusion: The causes of cognitive dysfunction are multiple especially in geriatric age groups. Poor awareness and illiteracy towards causes appear as major susceptible factors for identification of various physical disorders eventually leading to gross dysfunctions. Many often cognitive dysfunctions are taken complacently, attributing to the aging process and allow reversibility to slip into irreversibility.

Keywords: cognitive dysfunction, MMSE, vascular.

References

1. Prakash I J. Women and ageing. Indian J Med Res 1997;106:396-408.

2. Kumar V. Aging in India-an overview Indian J Med Res 1997;106:257-64.

3. IrudayaRajan S, Mishra US. Defining old age :An Indian assessment .J United Nations Institute Aging 1995;5:31-5.

4. Deepak Sharma, Salig Ram Mazta, Anupam Parashar :Prevalance of cognitive impairement and related factors among elderly:A Population –based study, Journal of Dr. NTR University of Health Sciences 2013;(3):171-176

5. JaswinderKaur , B.S. Sidhu , Raminderpal S. Sibia, Baldeep Kaur : Prevalance of Mild Cognitive Impairment among Hospital Patients aged 65 and above; Delhi Psychiatry Journal 2014; 17:(1)

6. Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985;102:164–168.

7. Snyder A, Fiegal DW, Arieff A. Hypernatremia in elderly patients: a heterogeneous, morbid, and iatrogenic entity. Ann Intern Med. 1987;107:309–319

8. J. D. Spence and J. Tuomilehto, “Control of hypertension forprevention of stroke,” World Stroke Academy, vol. 1, no. 4, pp.20–23, 2013.

9. P. B. Gorelick, “Risk factors for vascular dementia andAlzheimer disease,” Stroke, vol. 35, no. 11, pp. 2620–2622, 2004.

10. S. D. Israeli-Korn, M. Masarwa, E. Schechtman et al., “Hypertensionincreases the probability of Alzheimer’s disease and of mild cognitive impairment in an Arab community in northern Israel,” Neuroep-idemiology, vol 34, no2, pp 99–105, 2010.

11. C. Qiu, “Preventing Alzheimer’s disease by targeting vascularrisk factors: hope and gap,” Journal of Alzheimer’s Disease, vol.32, no. 3, pp. 721–731, 2012.

12. M. Igase, K. Kohara, and T. Miki, “The association betweenhypertension and dementia in the elderly,” International Journalof Hypertension, vol. 2012, Article ID 320648, 6 pages, 2012.

13. Cherubini, D. T. Lowenthal, E. Paran, P. Mecocci, L. S.Williams, and U. Senin, “Hypertension and cognitive functionin the elderly,” Disease-a-Month, vol. 56, no. 3, pp. 106–147, 2010.

14. Tzourio, C. Dufouil, P. Ducimetiere, and A. Alp ` erovitch, ´“Cognitive decline in individuals with high blood pressure: alongitudinal study in the elderly,” Neuro-logy, vol 53, no 9, pp1948–1952, 1999.

15. S. Gao, Y. Jin, F. W. Unverzagt et al., “Hypertension and cognitivedecline in rural elderly Chinese,” Journal of the AmericanGeriatrics Society, vol. 57, no. 6, pp. 1051–1057, 2009.

16. C. Qiu, B. Winblad, and L. Fratiglioni, “The age-dependent relation of blood pressure to cognitive function and dementia, ”The Lancet Neurology, vol. 4, no. 8, pp. 487–499, 2005.

17. F. C. Goldstein, A. I. Levey, and N. K. Steenland, “High bloodpressure and cognitive decline in mild cognitive impair-ment, ”Journal of the American Geriatrics Society, vol. 61, no. 1, pp. 67–73, 2013.

18. deWinter CF, Magilsen KW, van Alfen JC et al. Prevalence of cardiovascularrisk factors in older people with intellectual disability. Am J Intellect Dev Disabil 2009;114:427–36.

19. Bennett SJ, Sauve MJ. Cognitive deficits in patients with heart failure: A review of literature. J Cardiovasc Nurs. 2003; 18:219–42.

20. Barclay LL, Weiss EM, Mattis S, Bond O, Blass JP. Unrecognized cognitive impairment in cardiac rehabilitation patients. J Am Geriatr Soc. 1988;36:22–8.

21. Vrobel TR. Psychiatric aspects of congestive heart failure: Implications for consulting psychiatrists. Int J Psychiatry Med. 1989;19:211–25.

22. Sauve MJ, Walker JA, Massa SM, Winkle RA, Scheinman MM. Patterns of cognitive recovery in sudden cardiac arrest survivors: The pilot study. Heart Lung.1996;25:172–81.

23. Almeida OP, Tamai S. Congestive heart failure and cognitive functioning amongst older adults. Arq Neuropsiquiatr. 2001;59:324–9.

24. Bennett SJ, Sauve MJ. Cognitive deficits in patients with heart failure: A review of literature. J Cardiovasc Nurs. 2003; 18:219–42.

25. Zuccala G, Cattel C, Manes-Gravina E, Di-Niro MG, Cocchi A, Bernabei R. Left ventricular dysfunction: A clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry. 1997;63:509–12.

26. Almeida OP, Tamai S. Congestive heart failure and cognitive functioning amongst older adults. Arq Neuropsiquiatr. 2001; 59:324–9.

27. Almeida OP, Tamai S. Congestive heart failure and cognitive functioning amongst older adults. Arq Neuropsiquiatr. 2001; 59:324–10.

28. Zuccala G, Onder G, Pedone C, Carosella L, Pahor M, Bernabei R, et al. Hypotension and cognitive impairment: Selective association in patients with heart failure.Neurology. 2001;57:1986–92.

29. Zuccala G, Cattel C, Manes-Gravina E, Di-Niro MG, Cocchi A, Bernabei R. Left ventricular dysfunction: A clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry. 1997;63:509–12.

30. Cacciatore F, Abete P, Ferrara N, Calabrese C, Napoli C, Maggi S, et al. Congestive heart failure and cognitive impairment in an older population: Osservatorio Geriatrico Campano Study Group. JAm Geriatr Soc. 1998;46:1343-8.

Corresponding Author

Dr Shishir Pandey

Department of Medicine, Shyam Shah Medical College Rewa (M. P.), India

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