Outdoor temperature and blood pressure are strongly correlated in the elderly, especially in those 80 years or older. During periods of extreme temperatures, a careful monitoring of blood pressure and antihypertensive treatment could contribute to reducing the consequences of blood pressure variations in the elderly.
The French Hospital Database on HIV (FHDH) is a hospital-based multicentre open cohort with inclusions ongoing since 1989. The research objectives focus mainly on mid- and long-term clinical outcomes and therapeutic strategies, as well as severe AIDS and non-AIDS morbidities, and public health issues relative to HIV infection. FHDH also serves to describe HIV-infected patients receiving hospital care in France. FHDH includes data on more than 120,000 HIV-infected patients from 70 French general or university hospitals distributed throughout France. Patients are eligible for inclusion if they are infected by HIV-1 or HIV-2 and give their written informed consent. Standardized variables are collected at each outpatient visit or hospital admission during which a new clinical manifestation is diagnosed, a new treatment is prescribed or a change in biological markers is noted, and/or at least every 6 months. Since its inception, variables collected in FHDH include demographic characteristics, HIV-related biological markers, the date and type of AIDS and non AIDS-defining events, antiretroviral treatments and the date and causes of death, as reported in the medical records. Since 2005, data have also been collected on: co-infection with hepatitis B or C virus; alcohol and tobacco use; and non HIV-related biomarkers. Anyone can submit a research project by completing a standardized form available on the FHDH website (http://www.ccde.fr/_fold/fl-1385734776-429.pdf) or from the corresponding author, describing the context and objectives of the study. All projects are reviewed by the scientific committee.
In a large sample of elderly individuals from the general population, depressive individuals had lower blood pressure values than nondepressive ones, independent of medications and of history of cardiovascular events.
The aim of our study was to investigate whether depression assessed by different markers predicts the risk of incident dementia in elderly individuals. Data was derived from the 3C cohort study conducted in community-dwelling individuals aged 65 years and over, randomly recruited from electoral rolls of three French areas and followed up for four years (1999-2001 through 2004) with assessments every 2 years. The study sample comprised 7989 dementia-free individuals (mean age, 74.0 years; 61% women) assessed at baseline for current or past Major Depressive Episodes (MDE) based on MDE module of the Mini International Neuropsychiatric Interview, self-reported lifetime treated depression, and level of depressive symptoms using the Center for Epidemiologic Studies-Depression Scale. Fully adjusted Cox proportional hazards models were applied to examine the risk of incident dementia associated with these markers of depression. MDE and self-reported lifetime treated depression did not increase incident dementia risk. Conversely, high level of depressive symptoms at baseline was associated with a 50% increased risk of dementia (adjusted Hazard Ratio [HR], 1.5; 95% Confidence interval [CI], 1.2-2.2). This result was driven by a five-fold increased risk of vascular dementia (HR, 4.8; 95% CI, 2.2-10.7; p < 0.0001), whereas there was no increased risk of Alzheimer's disease (1.0; 0.7-1.6). In elderly individuals, high level of depressive symptoms is predictive of vascular dementia within a few years. This close temporal association suggests that depression is less a risk factor for than a prodromal symptom of vascular dementia.
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