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...

Fatty acid (FA), total lipid, protein, amino acid, carbon, nitrogen, and phosphorus content was analyzed in 24 samples of freshwater microalgae. The samples originated from batch, continuous, or mass cultures in various growth phases and from net samples from lakewater. FA were analyzed quantitatively by using an internal standard in a GLC system and expressed as mg·g−1 dry weight (DW). The FA of one group of blue‐greens (e.g. Oscillatoria and Microcystis) were similar to those of the greens with higher amounts of 18C acids of the ω3 type compared to the ω6 type, whereas the other group (e.g. Anabaena and Spirulina) contained mostly ω6 acids. The flagellates, a taxonomically diverse group, were characterized by high amounts of long‐chained (20–22 C) polyunsaturated FA (PUFA), particularly of the ω3 type. The ω3/ω6 ratio appears to be highest in algae in the exponential growth phase. The increased lipid content in stressed algae was mostly due to increased saturated fatty acids and ω6 acids, whereas the valuable ω3 acids were unchanged or even decreased. Amino acid composition (% of total amino acids) did not vary much betaken species, but when analyzed quantitatively (mg‐g−1 DW), varied considerably between species and within species in different growth phases. The nitrogen and phosphorus contents were variable in all three algal groups. The relationship between PUFA and phosphorus content differed among the algal groups. The data suggest that PUFA in the phospholipids consist mostly ω3 acids.

Insulin resistance is characterized by specific changes of the composition of fatty acids in the serum lipids and in the skeletal muscle membranes. Impaired insulin sensitivity is associated with high proportions of palmitic (16:0) acid and low levels of linoleic (18:2 n‐6) acid in serum. In addition, there are apparent changes of the fatty acid desaturase activities, suggesting an increased activity of the Δ9 and Δ6 desaturases and a decreased activity of the Δ5 desaturase. The activity of the fatty acid desaturases is regulated by long‐chain polyunsaturated fatty acids and insulin and is probably also dependent on the degree of physical activity. A high ratio between arachidonic (20:4 n‐6) and dihomo‐gamma linolenic (20:3 n‐6) acid, as a measure of Δ5 desaturase activity, in the skeletal muscle phospholipids has been related to good insulin sensitivity. Available knowledge seems to indicate that the degree of saturation of the body lipids, and especially the proportion of palmitic acid in the lipid membranes, may be critical for insulin sensitivity. The strong relationships between the Δ5 desaturase activity, a high content of long‐chain polyunsaturated fatty acids in the skeletal muscle, and insulin sensitivity may be due to parallel effects of diet and/or physical activity on the fatty acid composition and on insulin sensitivity.

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.

These data indicate that modifiable lifestyle factors mediate the inverse gradient between education and death from cerebro- and cardiovascular disease. Smoking, physical activity and dietary factors explained half of the excess cancer mortality in lower educated groups. Further studies are needed to explore the proposed association between palmitoleic acid, a marker of high intake of animal and dairy fat, and cancer.

1. Plankton net samples and sedimenting matter in traps from mesotrophic Lake Erken, Sweden, were analysed for carbon (C), nitrogen (N), phosphorus (P), total lipids and fatty acid (FA) content to determine what differences and seasonal changes might exist in the quality of food available to pelagic zooplankters and benthic invertebrates. 2. Matter collected in a plankton net was assumed to correspond to food available to pelagic grazers, while matter collected in sedimentation traps provided a measure of food available to benthic invertebrates. Furthermore, food quality was assumed to be related to polyunsaturated fatty acid (PUFA) content. 3. The results suggest that suspended particulate matter, collected with a plankton net, is a much higher‐quality food resource than sedimenting matter. Our data also show that only during the spring and autumn do the benthic fauna have access to high‐quality food, because of the dominance of diatoms during these periods. During summer, pelagic grazer production was probably limited by food quantity, whereas benthic invertebrate production was probably limited by food quality. 4. Plankton net samples showed consistently higher values than trap samples (% of dry weight, DW, or mg g–1 DW) for nearly all variables analysed: C, N, P, saturated FA (SAFA), monounsaturated FA (MUFA), PUFA, ω3 FA and ω6 FA. If N and P were expressed per C, the differences decreased and both data sets indicated moderate to no N or P limitation. N/P also showed well‐balanced ratios throughout most of the season, on average 10 and 7 (by weight), respectively. The largest differences between the two food resources occurred in the PUFA content, including the important FA of the ω3 type. The only FA with higher levels in the trap samples were some unidentified FA of relatively short chain lengths. Seasonal variation for most variables was also very large in both net and trap samples. 5. PUFA and ω3 FA showed good relationships with the P content of net samples, but not with that of trap samples. Eicosapentaenoic acid alone did not give a good relationship with P. Thus, P seems to be a good predictor of food quality in living phytoplankton but not in dead matter or detritus.

In 56 samples of freshwater fish, most were low in fat, ≤ 5% of dry weight (D.W.), and the sum of all fatty acids (ΣFA) was about 2% of D.W. Trout, whitefish, and grayling had the highest content of the long‐chained FA. of ω3 type, EPA and DHA (1·7–2·6% of D.W.). Two large, low‐fat pikes with ΣFA of about12–3% of D.W. and a medium‐fat whitefish had the highest ω3/ω6 ratios, 8–9, whereas the fattiest fishes, eels from two lakes and the Baltic (ΣFA =17–26% of D.W.) had lower ω3/ω6 ratios, 1·1–1·8 (ω3 and ω6 FA are two important series of FA). The results indicate that ΣA controls the content of saturated FA (SAFA) and monounsaturated FA (MUFA), whereas the polyunsaturated FA (PUFA) was independent of ΣFA after a break point of about 10%ΣFA of D.W. The P/S ratio (PUFA/SAFA) and the PUFA/ΣFA ratio decreased with increased ΣFA, whereas the ω3/ω6 ratio showed no clear correlation to ΣFA. The difference in fatty acid patterns lay between low‐fat and high‐fat fishes, rather than between marine and freshwater fishes. The variation, both within and between species of the separate FA is small in fish with similar ΣFA content. Also, low‐fat and medium‐fat fishes tend to be more dietarily favourable than high‐fat fishes, when considering the latest criteria for high nutritional value to humans. Abbreviations used in the text: FA, fatty acids; ΣFA, sum of all FA; AA, arachidonic acid (20 : 4ω6); EPA, eicosapentaenoic acid (20 : 5ω3); DHA, docosahexaenoic acid (22 : 6ω3); SAFA, saturated fatty acids; MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids; D.W., dry weight; F.W. fresh weight; CV, coefficient of variation; ω3 FA, series of PUFA with the first double bond located at carbon number 3; ω6 FA, series of PUFA with the first double bond located at carbon number 6. The fatty acids are described by three numbers, x:ywz, where x=number of carbon atoms, y=number of double bonds, and z=position of the first double bond counted from the methyl end of the molecule.

The Swedish Ticlopidine Multicentre Study (STIMS) was a double-blind placebo-controlled trial designed to determine whether ticlopidine, a platelet antiaggregatory agent, reduces the incidence of myocardial infarction, stroke and transitory ischaemic attacks in patients with intermittent claudication. A total of 687 patients was monitored for a minimum of 5 years or until an end-point was reached. The number of end points (99 vs. 89), analysed according to the intention-to-treat principle, was 11.4% lower in the ticlopidine group (P = 0.24). The mortality rate was 29.1% lower in the ticlopidine group (64 vs. 89, P = 0.015); this observation could be accounted for by a reduced mortality from ischaemic heart disease. On-treatment analysis showed there to be significantly fewer end points in the ticlopidine group (47 vs. 76, P = 0.017). Diarrhoea was the most common side-effect. Reversible leucopenia or thrombocytopenia was reported in seven patients on ticlopidine. It is concluded that the high morbidity and mortality from cardio- and cerebrovascular disease in patients with intermittent claudication can be reduced by long-term treatment with ticlopidine.