Risk of Subsequent Dementia in Patients with Hypertensive Encephalopathy: A Nationwide Population-Based Study in Taiwan

Abstract

Background/Aims: We investigated the association of hypertensive encephalopathy (HE) with subsequent dementia. Methods: Using universal insurance claims data, we identified a study cohort of 5,504 participants with HE newly diagnosed between 1997 and 2010 and a comparison cohort of 22,016 healthy participants. Incidence and risks of dementia were estimated for both cohorts until the end of 2010. Results: The dementia incidence was 1.45-fold [95% confidence interval (CI) = 1.27-1.66] higher in the study cohort than in the comparison cohort, with an adjusted hazard ratio (HR) of 1.38 (95% CI = 1.19-1.59) for the study cohort. The risk was higher for males than for females and elderly patients. With an incidence of 13.4 per 1,000 person-years, the HR of dementia increased to 2.09 (95% CI = 1.18-3.71) for the HE patients with the comorbidities of head injury and diabetes compared to those without HE and comorbidities. The risk of developing dementia declined with the follow-up time. Conclusion: Hypertensive patients with HE displayed a significantly higher risk for dementia than those without HE. The risk increased further in those with the comorbidities of head injury and diabetes. Physicians should be aware of the link between HE and dementia when assessing patients with HE.

Hypnotics use but not insomnia increased the risk of dementia in traumatic brain injury patients

“…Because perioperative stroke is a surgical complication that could potentially contribute to the development of vascular dementia, we excluded potential subjects with a diagnosis of atherosclerotic dementia (ICD-9-CM: 290.4).The survival time was defined as the period between the index date of insomnia and the occurrence of the study endpoint. Baseline prognostic factors were tracked from the index date to the end of 2008 or until loss to follow-up, and consisted of age; sex; comorbidities, including diabetes mellitus (DM), hypertension, hyperlipidemia, and stroke; intensive care unit (ICU) admission, the number of visits to an emergency department (ED), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or antidepressant drugs, all of which have been shown to be associated with dementia (Breitner et al, 2009;Cheng et al, 2012;Chi et al, 2013;Huang et al, 2014;Kessing et al, 2009;Meyer et al, 2000). Because the severity of brain injury was not available in the NHIRD files, we used ICU admission as an indicator of brain injury severity.…”

Tripartite intensive intervention for prevention of rebleeding in elderly patients with hypertensive cerebral hemorrhage

“…Rupture of blood vessels and formation of hematoma for various reasons will compress the surrounding brain tissue, leading to secondary brain injury and neurological impairment[ 4 - 7 ]. Because of the sudden onset and rapid progress of HICH, it usually manifests with lasting limb hemiplegia, language impairment, dysphagia, and other sequelae[ 8 - 12 ]. Patients in the convalescent period are prone to emotional excitement, which is not conducive to the rehabilitation process[ 13 - 16 ].…”