The overriding aim of my thesis was to study the relationship between blood pressure (BP) and cognitive and psychological functioning in older persons. Observational studies indicate that lower BP... Show moreThe overriding aim of my thesis was to study the relationship between blood pressure (BP) and cognitive and psychological functioning in older persons. Observational studies indicate that lower BP increases risk for cognitive decline in older persons. Older persons are at risk for impaired cerebral autoregulation, and lowering their BP may compromise cerebral blood flow and cognitive function. Contradictory to our hypothesis, the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study Leiden, a community-based randomized clinical trial in older persons (aged ≥75 years) with mild cognitive deficits, did not show that discontinuation of antihypertensive treatment improves cognitive functioning. The lack of the effect of this trial may be due to the unintentional inclusion of persons with a relatively intact cerebral autoregulation. Furthermore, we demonstrated that older persons with mild cognitive deficits and with orthostatic hypotension, who discontinued all their antihypertensive medication had an increased probability of being free from orthostatic hypotension 4 months later, compared to persons who continued their medication. Finally, in the DANTE MRI sub study, the relationship between BP and both conventional features of small vessel disease (SVD) and microstructural damage was explored, as well as the relation between microstructural damage and cognitive and psychological dysfunction. Show less
With increasing age the prevalence of hypertension rises. High blood pressure at midlife is associated with cognitive impairment. Nevertheless, in older persons a lower rather than a higher... Show more With increasing age the prevalence of hypertension rises. High blood pressure at midlife is associated with cognitive impairment. Nevertheless, in older persons a lower rather than a higher blood pressure is associated with incident dementia. The main purpose of the work in this thesis was to explore the role of blood pressure in relation to cerebral structure, neurocognitive functioning and hemodynamics of the brain in old age. Therefore, we sought to determine whether discontinuation of antihypertensive therapy in persons aged 75 years and over with mild cognitive deficits and using antihypertensive medication (the Discontinuation of ANtihypertensive Treatment in Elderly people [DANTE] population) would improve their cognitive and psychological functioning. The assumption was that the increase in blood pressure after the discontinuation of antihypertensives would lead to a direct increase in cerebral blood flow and, as a consequence, to an improvement in cerebral functioning. An additional objective was to investigate possible underlying mechanisms in the relation between blood pressure and neurocognitive functioning. To enable this, brain MRI was used to determine whether (lower) blood pressure was associated with (micro)structural damage, cerebral small vessel disease and blood flow in the brain, and also whether the presence of cerebral (micro)structural damage was related to neurocognitive functioning. Show less
In the Netherlands the Coping with Depression (CWD; Lewinsohn & Clark, 1984) course for elderly has been implemented in the prevention arm of the community-based mental health care system. The... Show moreIn the Netherlands the Coping with Depression (CWD; Lewinsohn & Clark, 1984) course for elderly has been implemented in the prevention arm of the community-based mental health care system. The study’s aim was the effectiveness (immediate and long-term) of the course in this real life setting. Enrolment of all 318 participants was the responsibility of the mental health care professionals in charge of the course. The immediate effect was studied in a random design using a waitlist group as control group; the long-term effect was analyzed in a naturalistic design. The Center for Epidemiological studies Depression scale (CES-D; Radloff, 1977) was used as the outcome measure. A wide range of variables related to incidence, severity, course and remittance of depression were included as predictors of immediate and long-term outcome. Results. The level of depressive symptoms varied from slight to being severely depressed i.e., meeting the criteria for a major depressive episode (MDE). Effect size: for non-depressed 0.32, for those with a MDE 0.92. The four predictors – anxiety, MDE, previous MDE, and education level - that were statistically significant had no clinical significance and did not justify further triage at intake. At the conclusion of the course 62% still had a CES-D score above 16, which is an indication that a clinical relevant depression is persisting. These participants should be advised to seek further treatment. Show less
