| With the ever-accelerating process of ageing populations, the incidence ofdementia is increasing year by year. Senile dementia has become one of theimportant topics of medical field. Cognitive impairment (CI) is the basicperformance and essential characteristics of dementia. The relationshipbetween hypertension and cognitive dysfunction has been attracting. Manystudies have shown that hypertension is an important factors which lead tocognitive dysfunction and even dementia. Atherosclerosis is an importantmechanism to cause cognitive dysfunction.ABI is simple, noninvasive and effective method for diagnosing theperipheral artery occlusive disease. It can accurately reflect the degree oflower limb extremity ischemia and the changes of arterial structure. Thecurrent researches have shown that atherosclerosis vascular diseases isvascular bed lesions, involving the whole body. ABI is an important index thatreflects the extent of atherosclerosis of the whole body. The decline of ABI isclosely related with cerebral arteriosclerosis, which influence the cognitivefunction directly.Pulse pressure index (PPI) is the ratio between average pulse pressure for24hours (24hSBP-24hDBP) and24hSBP, PPI narrows the variability of pulsepressure and overcomes the pulse pressure relativity, which is more objectivein evaluating the degree of danger and severity of vascular sclerosis. As agood clinical index to assess the degree of sclerosis of vascular, it can alsoreflect inherent and dynamic adaptability of vessel. The increased PPI leads tocerebral blood flow reduced, which increase ischemia of brain, may cause thedamage of cognitive function.This study analyzed of the relationship between ABI, PPI and cognitive function in610elderly cases of essential hypertension (EH). ABI and PPI, asearly predictors, are the important factors of cognitive impairment in theelderly patients with essential hypertension. If reasonable adjustment on thelevel of high blood pressure been done, the patients with reduced ABI andincreased pulse pressure index could get arteriosclerosis improved effectually.It is of clinical significance to early prevent and intervene cognitiveimpairment in the elderly hypertensives, and to obviously improve the qualityof life in the elderly patients with EH.Objective:To study the relationship between ankle-brachial index, pulse pressureindex and cognition function in the elderly patients with essential hypertension,in order to provide clinical evidence for ABI and PPI as early predictor of theelderly patients with essential hypertension.Methods:We randomly choose610cases of elderly patients (>60years old) withessential hypertension who hospitalized from December2009to June2011inthe department of geratology in the affiliated hospital of chengde medicalschool. According to the medical history, physical examination and auxiliaryexamination, excluding secondary hypertension, diabetes, cerebral thrombosisand cerebral embolism, hemorrhagic stroke, alzheimer’s disease and braintumors, demyelinated disease, low thyroid function, epilepsy, long-termdrinkers or other mental disease that can’t match with the inspectors and otherserious diseases.ABI were detected in all subjects. According to the ABI level, patientswere divided into abnormal group (ABI≤0.9, n=220)(observation group) andnormal group (1.3>ABI>0.9, n=390)(control group).Age, sex, the course ofhigh blood pressure, systolic blood pressure (SBP), diastolic pressure (DBP),pulse pressure (PP) and pulse pressure index (PPI), body mass index (BMI)and blood biochemical indicators between the two groups were observed.Cognitive functions were evaluated by mini-mental state examination(MMSE). Scores of MMSE and PPI between the two groups were compared. As logMMSE being the dependent variable, the risk factors of deceasedcognitive function being the independent variable, stepwise regression methodwas used in multiple stepwise regression, to analyze the related factors thathave influence on the cognitive function in patients with high blood pressure.Results:There were no significant differences between the two groups in gender,age, TC, TG, HDL-C, LDL-C, FPG, Cr, BUN, UA, BMI and the course ofhigh blood pressure (P>0.05); But the SBP (141±10.1vs135±16.8), PP(65.55±6.95vs59.52±11.6) and PPI (0.464±0.31vs0.438±0.53) in theobservation group were significantly higher than those in the control group,the differences were statistically significant (P<0.05).Scores of MMSE were significantly lower in observation group than thatof control group (23.4±1.8vs28.1±1.4, P<0.05). And there were significantdifferences between the two groups in ability of instant memory (1.84±0.68vs2.31±0.60), calculation (2.88±0.88vs3.58±0.82), prolonged recall (1.36±0.64vs1.97±0.73)(P<0.05).There were no significant differences between the twogroups in orientation (7.60±0.76vs7.93±0.88), language ability (6.56±0.82vs6.89±0.94)(P>0.05).LogMMSE was related with age, ankle brachial index, the course of highblood pressure, high-density lipoprotein cholesterol, uric acid and pulsepressure index by the analysis of stepwise regression method of multiplestepwise regression.Conclusion:The lower ABI and higher PPI is associated with cognitive impairment inthe elderly patients with essential hypertension. ABI and PPI can be taken aspredictor of cognitive impairment. To prevent and intervene cognitiveimpairment early in the elderly hypertensives, it has important clinical value toscreen ABI and PPI.. |
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