Abstract-Recent findings of a linkage between high blood pressure (BP) and later development of dementia have given new prospects on cerebral target-organ damage in hypertension and have added substance to the concept of "preventable senility." The aim of this study was to analyze the impact of hypertension, circadian BP profile, and disturbed glucose metabolism on cognitive function. The study population consisted of 999 seventy-year-old men from a population-based cohort study in Uppsala, Sweden, followed with respect to cardiovascular risk factors since the age of 50 years. At the age of 70, 24-hour ambulatory BP was monitored together with measurements of insulin sensitivity, glucose tolerance, serum lipids, and lipoproteins. Cognitive function was assessed by the Mini-Mental State Examination and the Trail-Making Test.High diastolic BP at baseline predicted later impaired cognitive performance, even after excluding men with a previous stroke (nϭ70). Cross-sectional measurements at age 70 showed that high 24-hour BP, nondipping, insulin resistance, and diabetes all were related to low cognitive function. The relationships between hypertension and cognitive impairment were strongest in untreated men. These data from a general population of healthy elderly men indicate that hypertension and associated metabolic disturbances might be susceptibility factors for cognitive disorders. The findings add support to possibilities of intervention in early stages in cognitive decline, ie, before manifest dementia. (Hypertension. 1998;31:780-786.)Key Words: cognition Ⅲ blood pressure monitoring, ambulatory Ⅲ diabetes Ⅲ insulin resistance T he question of whether some degree of cognitive deterioration is an inevitable part of aging or should be considered as a pathological prestage of dementia is currently debated. This is a field in need of research 1 because further decline in cognition might be preventable in the early stages of "cognitive impairment nondementia." Vascular dementia is a common form of dementia; in the oldest elderly patients it is as frequent as Alzheimer's disease.2 Recently, a 15-year follow-up study showed that high BP predicted dementia in the oldest elderly patients, irrespective of subtype.3 Little is known about how cognitive function is affected by vascular risk factors in the general population. The aim of the present study was to analyze the associations between BP, diurnal BP variation, disturbances in glucose and lipid metabolism, and cognition. We examined cognitive functions in a population-based cohort of 70-year-old men in which longitudinal measurements of vascular risk factors were available. MethodsThe study population consisted of 999 men. They were participants in a health survey focusing on cardiovascular risk factors that was started in the beginning of the 1970s in Uppsala, Sweden. The original cohort was defined as all men born in 1920 to 1924, who resided in the municipality of Uppsala in 1970Uppsala in to 1973. A total of 2322 (81.7%) men participated in the baseline examina...

Capsulotomy is effective in reducing OCD symptoms. There is a substantial risk of adverse effects, and the risk may vary between surgical methods. Our findings suggest that smaller lesions are safer and that high radiation doses and multiple procedures should be avoided.

Background and Purpose-Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke. Methods-This was a cross-sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini-Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account. Results-All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (nϭ44) had lower mean adjusted cognitive z scores (Ϫ0.26Ϯ0.11) than men without atrial fibrillation (ϩ0.14Ϯ0.03; Pϭ0.0003).The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was Ϫ0.24Ϯ0.12 in the 36 men with atrial fibrillation and ϩ0.17Ϯ0.03 in those without atrial fibrillation (Pϭ0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (nϭ27) performed markedly better (Ϫ0.05Ϯ0.21) than those without treatment (nϭ9; Ϫ1.14Ϯ0.34; adjusted Pϭ0.0005). Previous myocardial infarction was not associated with impaired cognitive results. Conclusions-In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.

Background Cognitive impairment is a clinically important feature of schizophrenia. Polygenic risk score (PRS) methods have demonstrated genetic overlap between schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), educational attainment (EA), and IQ, but very few studies have examined associations between these PRS and cognitive phenotypes within schizophrenia cases. Methods We combined genetic and cognitive data in 3034 schizophrenia cases from 11 samples using the general intelligence factor g as the primary measure of cognition. We used linear regression to examine the association between cognition and PRS for EA, IQ, schizophrenia, BD, and MDD. The results were then meta-analyzed across all samples. A genome-wide association studies (GWAS) of cognition was conducted in schizophrenia cases. Results PRS for both population IQ (P = 4.39 × 10–28) and EA (P = 1.27 × 10–26) were positively correlated with cognition in those with schizophrenia. In contrast, there was no association between cognition in schizophrenia cases and PRS for schizophrenia (P = .39), BD (P = .51), or MDD (P = .49). No individual variant approached genome-wide significance in the GWAS. Conclusions Cognition in schizophrenia cases is more strongly associated with PRS that index cognitive traits in the general population than PRS for neuropsychiatric disorders. This suggests the mechanisms of cognitive variation within schizophrenia are at least partly independent from those that predispose to schizophrenia diagnosis itself. Our findings indicate that this cognitive variation arises at least in part due to genetic factors shared with cognitive performance in populations and is not solely due to illness or treatment-related factors, although our findings are consistent with important contributions from these factors.

Objectives.A low level of education is associated with an increased risk of developing a dementia disorder, as well as with a higher risk of cardiovascular disease. The aim of this study was to investigate the association between education and cardiovascular risk factors, and to study the relation between these factors and cognitive function in elderly men. Design. Cross-sectional population-based study. Setting. Uppsala, Sweden. Subjects. 504 men aged 69-74 years, participants in a longitudinal health survey concerning cardiovascular risk factors. Main outcome measure. Cognitive function as measured by a composite score of 13 standard psychometric tests. Results.A low level of education was associated with poorer cognitive performance, as well as with obesity, smoking, diabetes, high concentrations of serum triglycerides and plasma fibrinogen. In the entire cohort, subjects with obesity, smoking, diabetes or hypertriglyceridaemia showed impaired cognitive test results, independent of socio-economic factors. When stroke cases were excluded, obesity and smoking were still related to impaired cognitive function. Conclusions. Smoking and obesity with associated metabolic disturbances are inversely related both to educational level and to cognitive function. Cognitive decline of vascular origin is potentially preventable by treatment of risk factors. The question of whether the increased vascular risk contributes to the higher prevalence of cognitive disorders in individuals with low socio-economic status, needs to be further evaluated in longitudinal population-based studies.

Thermocapsulotomy is an effective treatment for selected cases of nonobsessive anxiety but may carry a significant risk of adverse symptoms indicating impairment of frontal lobe functioning. These findings underscore the importance of face-to-face assessments of adverse symptoms.

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Neurocognitive performance at admission appears to predict various aspects of functional outcome in FEP.