Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia

Background: This is an update of a previous review (McGuinness 2006). Hypertension and cognitive impairment are prevalent in older people. Hypertension is a direct risk factor for vascular dementia (VaD) and recent studies have suggested hypertension impacts upon prevalence of Alzheimer's disease (AD). Therefore does treatment of hypertension prevent cognitive decline?
Objectives: To assess the effects of blood pressure lowering treatments for the prevention of dementia and cognitive decline in patients with hypertension but no history of cerebrovascular disease.
Search strategy: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources were searched on 13 February 2008 using the terms: hypertens$ OR anti-hypertens$. Selection criteria: Randomized, double-blind, placebo controlled trials in which pharmacological or non-pharmacological interventions to lower blood pressure were given for at least six months.
Data collection and analysis: Two independent reviewers assessed trial quality and extracted data. The following outcomes were assessed: incidence of dementia, cognitive change from baseline, blood pressure level, incidence and severity of side effects and quality of life.
Main results: Four trials including 15,936 hypertensive subjects were identified. Average age was 75.4 years. Mean blood pressure at entry across the studies was 171/86 mmHg. The combined result of the four trials reporting incidence of dementia indicated no significant difference between treatment and placebo (236/7767 versus 259/7660, Odds Ratio (OR) = 0.89, 95% CI 0.74, 1.07) and there was considerable heterogeneity between the trials. The combined results from the three trials reporting change in Mini Mental State Examination (MMSE) did not indicate a benefit from treatment (Weighted Mean Difference (WMD) = 0.42, 95%CI 0.30, 0.53). Both systolic and diastolic blood pressure levels were reduced significantly in the three trials assessing this outcome (WMD = -10.22, 95% CI -10.78, -9.66 for systolic blood pressure, WMD = -4.28, 95% CI -4.58, -3.98 for diastolic blood pressure). Three trials reported adverse effects requiring discontinuation of treatment and the combined results indicated no significant difference (OR = 1.01, 95% CI 0.92, 1.11). When analysed separately, however, more patients on placebo in Syst Eur 1997 were likely to discontinue treatment due to side effects; the converse was true in SHEP 1991. Quality of life data could not be analysed in the four studies. Analysis of the included studies in this review was problematic as many of the control subjects received antihypertensive treatment because their blood pressures exceeded pre-set values. In most cases the study became a comparison between the study drug against a usual antihypertensive regimen.
Authors' conclusions: There is no convincing evidence fromthe trials identified that blood pressure lowering in late-life prevents the development of dementia or cognitive impairment in hypertensive patients with no apparent prior cerebrovascular disease. There were significant problems identified with analysing the data, however, due to the number of patients lost to follow-up and the number of placebo patients who received active treatment. This introduced bias. More robust results may be obtained by conducting a meta-analysis using individual patient data.

Evidence-based Practice in Cognitive-Behaviour Therapy

book review

Large-Range Movements of Neotropical Orchid Bees Observed via Radio Telemetry

Neotropical orchid bees (Euglossini) are often cited as classic examples of trapline-foragers with potentially extensive foraging ranges. If long-distance movements are habitual, rare plants in widely scattered locations may benefit from euglossine pollination services. Here we report the first successful use of micro radio telemetry to track the movement of an insect pollinator in a complex and forested environment. Our results indicate that individual male orchid bees (Exaerete frontalis) habitually use large rainforest areas (at least 42-115 ha) on a daily basis. Aerial telemetry located individuals up to 5 km away from their core areas, and bees were often stationary, for variable periods, between flights to successive localities. These data suggest a higher degree of site fidelity than what may be expected in a free living male bee, and has implications for our understanding of biological activity patterns and the evolution of forest pollinators.

Hybrid image/ray-shooting UHF radio propagation predictor for populated indoor environments

A novel model for indoor wireless communication, based on a dual image and ray-shooting approach, is presented. The model, capable of improved site-specific indoor propagation prediction, considers multiple human bodies moving within the environment. In a modern office at 2.45GHz, the combined effect of pedestrian traffic and a moving receiver causes rapid temporal fading of up to 30dB.

RF performance of a 418-MHz radio telemeter packaged for human vaginal placement

The electrical and communication performance of a 0.8-mu W UHF temperature telemeter designed for human vaginal placement is discussed; a solenoidal loop antenna was used, occupying a volume of 0.1 cm(3). In situ, measured power absorption was between 19-25 dB, resulting in an effective operating range of 10 m. Capacitive loading lowered the antenna's resonant frequency by 1.4% and there was a significant polarization change in the radiated output.

Vaginal temperature sensing using UHF radio telemetry

User induced errors are common when women repetitively employ conventional probe type thermometers to chart their basal body temperatures in an effort to indicate ovulation. An alternative technique employing a two-part telemetric thermometer is proposed, with low-power, SAWR-controlled UHF radio as the transmission medium. Worn overnight in the vagina, the 1 mu W erp telemetry transmitter sends pulse modulated data continuously to a microcontroller in a nearby receiver; a real time clock enables programmable sampling and storage of the subject's temperature to 0.1 degrees C resolution. Initial clinical results indicate an enhanced performance compared to oral and axillary temperature trends taken by a mercury-in-glass thermometer. Polar plots of both the isolated and body-worn telemetry transmitte are presented; body indced attenuations of up to 30 dB were measured.

Genetic variation in the interleukin-1 beta-converting enzyme associates with cognitive function. The PROSPER study

Inflammation is thought to play an important role in the development of cognitive decline and dementia in old age. The interleukin-1 signalling pathway may play a prominent role in this process. The gene encoding for interleukin-1 beta-converting enzyme (ICE) is likely to influence IL-1 beta levels. Inhibition of ICE decreases the age-related increase in IL-1 beta levels and may therefore improve memory function. We assessed whether genetic variation in the ICE gene associates with cognitive function in an elderly population. All 5804 participants of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) were genotyped for the 10643GC, 9323GA, 8996AG and 5352GA polymorphisms in the ICE gene. Cross-sectional associations between the polymorphisms and cognitive function were assessed with linear regression. Longitudinal associations between polymorphisms, haplotypes and cognitive function were assessed with linear mixed models. All associations were adjusted for sex, age, education, country, treatment with pravastatin and version of test where appropriate. Subjects carrying the variants 10643C and 5352A allele had significantly lower IL-1 beta production levels (P

Transmission characteristics of a vaginally-worn UHF radio telemeter

A vaginally-worn temperature telemeter may be used by women to chart their basal body temperature for ovulation detection. The telemeter uses a temperature to pulse width converter to key a Colpitts oscillator which is controlled in frequency by a 418 MHz SAW resonator. The circuit’s tank inductor acts as a compact, multi-turn loop antenna with a radiated power in isolation of around 1 uW. The transmission characteristics of the system are affected by the proximity of the human body, which acts as an electrically-large lossy dielectric. The RF link-budget must allow for the reduction in total emitted power, directional body-induced fading, and polarization effects. The polar power patterns of the telemeter were measured for both isolated and in-situ cases, using horizontal and vertical polarization. The power patterns were numerically integrated to determine relative emitted power, and a reference dipole used to determine the emitted power for the isolated device. In isolation the telemeter radiation is vertically polarized and isotropic in nature. With the telemeter in-situ, total body absorption was found to be over 20 dB, with directional fades of up to 40 dB; there was extensive cross-polarization, with up to 60% of radiated power horizontally polarized. With limited radiated power and directional fading, the operating range for the telemeter is limited to single room operation (less than 10m). The majority of RF radiation is absorbed by the body, but the radiation hazard is negligible due to the low power level of the device. The high level of cross-polarization suggests that either horizontal or vertically polarized base-station antennas may be used.