Secondary Stroke Prevention in the Very Elderly in Real Life: PP.4.139

Abstract

Objective: Exposure to high altitude reduces oxygen supply to the central nervous system and may cause neuropsychological impairment. Aim of our study was to evaluate changes in neuropsychological performances of normal subjects when exposed to high and very high altitude, i.e. to conditions representing an experimental model for investigating cognitive functional changes occurring in clinical conditions characterized by reduced brain oxygen supply, such as obstructive sleep apnea or hypertension-related cerebrovascular damage.Design and Method: Forty-five normal subjects participating in the Himalaya's HIGHCARE expedition underwent an extensive neuropsychological and psychodiagnostic assessment at sea level (SL), at 3500 m and at 5400 m altitudes. Different cognitive domains were investigated with paper and pencil tools as well as with computerized tests (X50 eye-tracking device). Psychological status was assessed by clinical checklists.Results: While classic paper and pencil tests did not detect major changes with altitude, better cognitive performances scores were obtained in normoxia and at 3500 m than at 5400 m for computerized psychomotor (keyboard reaction times, KRT) and eye reaction times (ERT): KRT SL vs 5400 m 0.59 AE 0.15 sec vs 0.67 AE 0.17 sec (p < 0.04); KRT SL vs 3500 m 0.59 AE 0.15 sec vs 0.62 AE 0.17 sec (n.s.); KRT 3500 m vs 5400 m 0.62 AE 0.17 sec vs 0.67 AE 0.17 sec (n.s.). ERT SL vs 5400 m 0.44 AE 0.06 sec vs 0.46 AE 0.04 sec (p < 0.001); ERT SL vs 3500m 0.44 AE 0.06 sec vs 0.42 AE 0.05 sec (p < 0.007); ERT 3500m vs 5400m 0.42 AE 0.05 sec vs 0.46 AE 0.04 sec (p < 0.02).ERT were positively related to respiratory rate (RR) (r = 0.53, P < 0.0007). Gender differences were detected, with women having a better performance than men on psychomotor efficiency (% KRT responses) at 5400 m (p < 0.001).Conclusions: High altitude exposure induces specific alterations in cognitive functions, with significant impairment in cognitive performances at 5400m. Our data suggest that computerized tests used for the assessment could be more sensitive than paper and pencil ones, being able to detect even minimal hypoxia-induced changes in cognitive functions. Thus they might be useful in highlighting mild cognitive changes also in hypertensive patients with increased cerebrovascular risk.Objective: Left ventricular hypertrophy (LVH) has been increasingly recognized as a risk factor for stroke. Characterization of blood pressure (BP) using the 24-hour ambulatory blood pressure monitoring (ABPM) is superior to casual measurement in predicting cardiovascular target organ damage in patients with arterial hypertension. We aimed to determine the relationship between LVH and ABPM in patients after acute ischemic stroke.Design and method: We studied 80 subjects with acute ischemic stroke who underwent 24-h ABPM and cross-sectional and M-mode echocardiography. After six month a new ABPM was undergone. Patients were divided into two groups by presence and absence of LVH. Results:We included 40 patients with LVH and 40 patient...

Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

“…Brescacin et al. 20 , in a study published in 2010, showed that long-standing hypertension is one of the main reasons for a reduction in life expectancy in subjects with stroke. The present study showed that such complication was more frequent among hypertensive individuals, both at admission and during follow-up, even in those with better BP control.…”