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.

Perceptions of aging across 26 cultures and their culture-level associates

College students (N = 3,435) in 26 cultures reported their perceptions of age-related changes in physical, cognitive, and socioemotional areas of functioning and rated societal views of aging within their culture. There was widespread cross-cultural consensus regarding the expected direction of aging trajectories with (a) perceived declines in societal views of aging, physical attractiveness, the ability to perform everyday tasks, and new learning; (b) perceived increases in wisdom, knowledge, and received respect; and (c) perceived stability in family authority and life satisfaction. Cross-cultural variations in aging perceptions were associated with culture-level indicators of population aging, education levels, values, and national character stereotypes. These associations were stronger for societal views on aging and perceptions of socioemotional changes than for perceptions of physical and cognitive changes. A consideration of culture-level variables also suggested that previously reported differences in aging perceptions between Asian and Western countries may be related to differences in population structure.

On the Performance of Eigenvalue-Based Cooperative Spectrum Sensing for Cognitive Radio

In this paper, the distribution of the ratio of extreme eigenvalues of a complex Wishart matrix is studied in order to calculate the exact decision threshold as a function of the desired probability of false alarm for the maximum-minimum eigenvalue (MME) detector. In contrast to the asymptotic analysis reported in the literature, we consider a finite number of cooperative receivers and a finite number of samples and derive the exact decision threshold for the probability of false alarm. The proposed exact formulation is further reduced to the case of two receiver-based cooperative spectrum sensing. In addition, an approximate closed-form formula of the exact threshold is derived in terms of a desired probability of false alarm for a special case having equal number of receive antennas and signal samples. Finally, the derived analytical exact decision thresholds are verified with Monte-Carlo simulations. We show that the probability of detection performance using the proposed exact decision thresholds achieves significant performance gains compared to the performance of the asymptotic decision threshold.

Evidence-based Practice in Cognitive-Behaviour Therapy

book review

Developing students’ ability to engage critically with science in the news: identifying elements of the ‘media awareness’ dimension

Worldwide, science education reform movements are stressing the need to promote ‘scienti?c literacy’ among young people. Increasingly, this is taken to include empowering students to engage critically with science-related news reporting. Despite this requirement now featuring in statutory curricula throughout the UK, there has, to date, been a dearth of research-informed advice to assist science teachers as they identify appropriate instructional objectives in this regard and design relevant learning activities through which these might be achieved. In this study, prominent science communication
scholars, science journalists, science educators and media educators were interviewed to determine what knowledge, skills and habits of mind they judged valuable for individuals reading science-related news stories. Teachers of science and of English from nine secondary schools in Northern Ireland addressed the same issue. A striking – and signi?cant – ?nding of the study was the very substantial number of statements of knowledge, skill and disposition o?ered by participants that relate to ‘media awareness’, an issue largely overlooked in the science education literature. The school-focused phase of the research suggests that cross-curricular approaches involving teachers of science collaborating with those of English/media education or media studies may best serve to address this important curricular goal.

Are causal and intervention judgments inextricably linked? A developmental study.

The application of the formal framework of causal Bayesian Networks to children's causal learning provides the motivation to examine the link between judgments about the causal structure of a system, and the ability to make inferences about interventions on components of the system. Three experiments examined whether children are able to make correct inferences about interventions on different causal structures. The first two experiments examined whether children's causal structure and intervention judgments were consistent with one another. In Experiment 1, children aged between 4 and 8years made causal structure judgments on a three-component causal system followed by counterfactual intervention judgments. In Experiment 2, children's causal structure judgments were followed by intervention judgments phrased as future hypotheticals. In Experiment 3, we explicitly told children what the correct causal structure was and asked them to make intervention judgments. The results of the three experiments suggest that the representations that support causal structure judgments do not easily support simple judgments about interventions in children. We discuss our findings in light of strong interventionist claims that the two types of judgments should be closely linked. © 2011 Cognitive Science Society, Inc.


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Children’s Reasoning About the Temporal Order of Past and Future Events

Four- and five-year-olds completed two sets of tasks that involved reasoning about the temporal order in which events had occurred in the past or were to occur in the future. Four-year-olds succeeded on the tasks that involved reasoning about the order of past events but not those that involved reasoning about the order of future events, whereas 5-year-olds passed both types of tasks. Individual children who failed the past-event tasks were not particularly likely to fail the more difficult future-event tasks. However, children's performance on the reasoning tasks was predictive of their performance on a task assessing their comprehension of the terms “before” and “after.” Our results suggest that there may be a developmental change over this age range in the ability to flexibly represent and reason about the before-and-after relationships between events.