(精选)Clinical Trials of Anti-Hypertensive Medication for MCI ...教学课件.pptVIP

But…..both risk factors and dementia needs to be detected….. Many people have hypertension without knowing it Many people have dementia or cognitive impairment which is not detected The latter may have implications for adherence to medications for physical disorders Lille, France 12-14 Septembre 2011 Vas-Cog2011 Declining blood pressure before dementia onset A 15-year follow-up of blood pressure and dementia Skoog et al. Lancet 1996 SAMPLES SHEP 160-219/90 MRC 160-209/115 Syst-Eur 160-219/95 No dementia PROGRESS Prior stroke or TIA Mean age 64 SCOPE 160-179/90-99 MMSE 24-30 No dementia HYVET SBP 160 If lowered blood pressure is a marker of preclinical dementia, those included in hypertension trials may be at low short-term risk for dementia Methodological issues Healthy volunteer effect Selective attrition / missing data Time of follow-up Diagnosis and detection of dementia Testing Ceiling effect Learning effect Sensitivity to change Subgroups? Risk groups? Type of drug Effect other than blood pressure CHANGE IN MMSE SCORE Ceiling effect in those with 29-30 Learning effect (test every 6 months) Less possibility for increase in those with 29-30 MMSE 30 MMSE 30 CHANGE IN COGNITIVE FUNCTION MMSE 24 CHANGE IN MMSE SCORE Ceiling effect in those with 29-30 Learning effect (test every 6 months) Less possibility for increase in those with 29-30 Increase in test scores MRC trial in hypertension Syst-Eur SCOPE CHANGE IN MMSE SCORE Ceiling effect in those with 29-30 Learning effect (test every 6 months) Less possibility for increase in those with 29-30 CHANGE IN MMSE SCORE FROM BASELINE (SCOPE) MMSE score at baseline Increase % Decrease % 30 (N=1653) 0 44 29 (N=1214) 36 37 28 (N=929) 43 34 27 (N=528) 49 37 26 (N=354) 49 37 25 (N=177) 54 33 24 (N=81) 36 45 Methodological issues Healthy volunteer effect Selective attrition / missing data Time of follow-up Diagnosis and detection of dementia Testing Ceiling effect Learning effect Sensitivity to c