Advertisement

Is cognitive status of the Cretan elderly aged ≥ 75 years associated with known behavioral and vascular risk factors?

  • Ioanna StefanakiEmail author
  • Manolis Linardakis
  • Christos Lionis
Original Article
  • 20 Downloads

Abstract

Purpose

This study aimed to examine the association of blood hypertension and certain behavioral risk factors with cognitive decline in elderly individuals.

Methods

A subsample of 92 elderly people aged ≥ 75 years was taken from 411 people (aged 65+ years) living in a rural area of Crete, Greece. Detailed medical and family/social history data were recorded on a standard validated health card, and cognitive disorders were assessed using the Mini Mental State Examination (MMSE). The participants were evaluated for behavioral risk factors such as physical inactivity, smoking, alcohol consumption and dietary habits. Multiple logistic regression analysis was conducted to assess the risk (odds ratios, OR) of cognitive impairment.

Results

The mean age of participants was 80.8 ± 4.3 years old with 66.3% being married, and their MMSE mean score was 23.4 ± 4.6; 46.7% had severe and/or mild symptoms of cognitive decline, while more than half (67.4%) had been diagnosed with hypertension. Living alone (OR: 3.48, p = 0.034), being physically inactive (OR: 5.65, p = 0.046) and low consumption of fruits and vegetables (OR: 4.16, p = 0.018) were found to increase the odds of cognitive impairment, while elderly people with hypertension were also found to have lower odds of cognitive impairment (OR: 0.42, p > 0.05).

Conclusion

Although the observational character of this study carries some potential limitations, the reverse association of cognitive capacity with hypertension constitutes a ‘paradox’ phenomenon and is in contrast to the current literature. Further research with a larger sample is needed to better understand the observed association.

Keywords

Elderly Cognitive status Cardiovascular disease Hypertension Risk factor Primary care 

Abbreviations

MMSE

Mini Mental State Examination

Notes

Compliance with ethical standards

Research Involving Human Participants

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the University Hospital of Heraklion, Crete, Greece (no. 82, 3/20.07.2005) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Anyfantakis D, Symvoulakis EK, Linardakis M, Shea S, Panagiotakos D, Lionis C (2015) Effect of religiosity/spirituality and sense of coherence on depression within a rural population in Greece: the Spili III project. BMC Psychiatry 15:173.  https://doi.org/10.1186/s12888-015-0561-3 CrossRefPubMedPubMedCentralGoogle Scholar
  2. Aronow WS (2017) Hypertension and cognitive impairment. Ann Transl Med 5:259.  https://doi.org/10.21037/atm.2017.03.99 CrossRefPubMedPubMedCentralGoogle Scholar
  3. Birns J, Kalra L (2009) Cognitive function and hypertension. J Hum Hypertens 23:86–96.  https://doi.org/10.1038/jhh.2008.80 CrossRefPubMedGoogle Scholar
  4. Chalmers J (2015) Can blood pressure-lowering therapy reduce the risk of cognitive decline in the elderly? J Hypertens 33:2029–2031.  https://doi.org/10.1097/HJH.0000000000000671 CrossRefPubMedGoogle Scholar
  5. Chobanian A, Bakris G, Black H, Cushman W, Green L, Izzo JJ et al (2003) Seventh report of the joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252.  https://doi.org/10.1161/01.HYP.0000107251.49515.c2 CrossRefPubMedGoogle Scholar
  6. Ciobica A, Padurariu M, Bild W, Stefanescu C (2011) Cardiovascular risk factors as potential markers for mild cognitive impairment and Alzheimer’s disease. Psychiatr Danub 23:340–346PubMedGoogle Scholar
  7. Corrada MM, Hayden KM, Paganini-Hill A, Bullain SS, DeMoss J, Aguirre C et al (2017) Age of onset of hypertension and risk of dementia in the oldest-old: the 90+ study. Alzheimers Dement 13:103–110.  https://doi.org/10.1016/j.jalz.2016.09.007 CrossRefPubMedPubMedCentralGoogle Scholar
  8. Delgado J, Masoli JAH, Bowman K, Strain WD, Kuchel GA, Walters K et al (2017) Outcomes of treated hypertension at age 80 and older: cohort analysis of 79,376 individuals. J Am Geriatr Soc 65:995–1003.  https://doi.org/10.1111/jgs.14712 CrossRefPubMedGoogle Scholar
  9. Folstein MF, Folstein SE, McHugh PR (1975) "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  10. Freidl W, Schmidt R, Stronegger WJ, Irmler A, Reinhart B, Koch M (1996) Mini mental state examination: influence of sociodemographic, environmental and behavioral factors and vascular risk factors. J Clin Epidemiol 49:73–78CrossRefPubMedGoogle Scholar
  11. Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB et al (2016) Impact of hypertension on cognitive function: a scientific statement from the American Heart Association. Hypertension.  https://doi.org/10.1161/hyp.0000000000000053
  12. Igase M, Kohara K, Miki T (2012) The association between hypertension and dementia in the elderly. Int J Hypertens 2012.  https://doi.org/10.1155/2012/320648
  13. Jelastopulu E, Giourou E, Argyropoulos K, Kariori E, Moratis E, Mestousi A et al (2014) Demographic and clinical characteristics of patients with dementia in Greece. Advances in Psychiatry 2014:7.  https://doi.org/10.1155/2014/636151 CrossRefGoogle Scholar
  14. Kafatos A, Diacatou A, Voukiklaris G, Nikolakakis N, Vlachonikolis J, Kounali D et al (1997) Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the seven countries study. Am J Clin Nutr 65:1882–1886CrossRefPubMedGoogle Scholar
  15. Kennedy A, Lavie CJ, Blair SN (2018) Fitness or fatness: which is more important? JAMA 319:231–232.  https://doi.org/10.1001/jama.2017.21649 CrossRefPubMedGoogle Scholar
  16. Koenig H (2012) Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry 2012:278730.  https://doi.org/10.5402/2012/278730 CrossRefPubMedPubMedCentralGoogle Scholar
  17. Linardakis M, Smpokos E, Papadaki A, Komninos ID, Tzanakis N, Philalithis A (2013) Prevalence of multiple behavioral risk factors for chronic diseases in adults aged 50+, from eleven European countries—the SHARE study (2004). Prev Med 57:168–172.  https://doi.org/10.1016/j.ypmed.2013.05.008S0091-7435(13)00153-9 CrossRefPubMedGoogle Scholar
  18. Lionis C, Faresjo A, Skoula M, Kapsokefalou M, Faresjo T (1998) Antioxidant effects of herbs in Crete. Lancet 352:1987–1988.  https://doi.org/10.1016/S0140-6736(05)61333-5 CrossRefPubMedGoogle Scholar
  19. Loprinzi PD, Crush E, Joyner C (2017) Cardiovascular disease biomarkers on cognitive function in older adults: joint effects of cardiovascular disease biomarkers and cognitive function on mortality risk. Prev Med 94:27–30.  https://doi.org/10.1016/j.ypmed.2016.11.011 CrossRefPubMedGoogle Scholar
  20. Moreira A, Diógenes M, de Mendonça A, Lunet N, Barros H (2016) Chocolate consumption is associated with a lower risk of cognitive decline. J Alzheimers Dis 53:85–93.  https://doi.org/10.3233/JAD-160142 CrossRefPubMedGoogle Scholar
  21. Mottaghi T, Amirabdollahian F, Haghighatdoost F (2017) Fruit and vegetable intake and cognitive impairment: a systematic review and meta-analysis of observational studies. Eur J Clin Nutr.  https://doi.org/10.1038/s41430-017-0005-x
  22. Parsons C, Murad MH, Andersen S, Mookadam F, Labonte H (2016) The effect of antihypertensive treatment on the incidence of stroke and cognitive decline in the elderly: a meta-analysis. Futur Cardiol 12:237–248.  https://doi.org/10.2217/fca.15.90 CrossRefGoogle Scholar
  23. Peters R, Beckett N, Forette F, Tuomilehto J, Clarke R, Ritchie C et al (2008) Incident dementia and blood pressure lowering in the hypertension in the very elderly trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol 7:683–689.  https://doi.org/10.1016/S1474-4422(08)70143-1 CrossRefPubMedGoogle Scholar
  24. Sabayan B, Sorond F (2017) Reducing risk of dementia in older age. JAMA 317:2028–2028.  https://doi.org/10.1001/jama.2017.2247 CrossRefPubMedGoogle Scholar
  25. Sarri KO, Linardakis M, Tzanakis N, Kafatos AG (2008) Adipose DHA inversely associated with depression as measured by the Beck depression inventory. Prostaglandins Leukot Essent Fat Acids 78:117–122.  https://doi.org/10.1016/j.plefa.2007.12.004 CrossRefGoogle Scholar
  26. Stefanaki IN, Shea S, Linardakis M, Symvoulakis EK, Wynyard R, Lionis C (2014) Exploring the association of sense of coherence, and spiritual and religious beliefs in a rural population group on the island of Crete, Greece. Int J Psychiatry Med 47:207–230.  https://doi.org/10.2190/PM.47.3.cA77312T027135110 CrossRefPubMedGoogle Scholar
  27. Tsolaki M, Kakoudaki T, Tsolaki A, Verykouki E, Pattakou V (2014) Prevalence of mild cognitive impairment in individuals aged over 65 in a rural area in North Greece. Advances in Alzheimer’s Disease 3:11–19CrossRefGoogle Scholar
  28. Vergetaki A, Papadaki A, Linardakis M, Kafatos A (2018) Changes in 10-year cardiovascular risk and behavioral risk factors in men in Crete, Greece, since the seven countries’ study (1960–1997). J Public Health.  https://doi.org/10.1007/s10389-017-0879-z
  29. Watfa G, Benetos A, Kearney-Schwartz A, Labat C, Gautier S, Hanon O et al (2015) Do arterial hemodynamic parameters predict cognitive decline over a period of 2 years in individuals older than 80 years living in nursing homes? The PARTAGE study. J Am Med Dir Assoc 16:598–602.  https://doi.org/10.1016/j.jamda.2015.01.098 CrossRefPubMedGoogle Scholar
  30. WHO (2002) The World health report 2002: reducing risks, promoting healthy life: overview. GenevaGoogle Scholar
  31. Wu L, Sun D, Tan Y (2017) Intake of fruit and vegetables and the incident risk of cognitive disorders: a systematic review and meta-analysis of cohort studies. J Nutr Health Aging 21:1284–1290.  https://doi.org/10.1007/s12603-017-0875-6 CrossRefPubMedGoogle Scholar
  32. Yeung W, Chan Y (2007) The positive effects of religiousness on mental health in physically vulnerable populations: a review on recent empirical studies and related theories. Int J Psychosoc Rehabil 11:37–52Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Rural Surgery of EmbarosHealth Centre of ViannosHeraklionGreece
  2. 2.Clinic of Social and Family Medicine, School of MedicineUniversity of CreteHeraklionGreece

Personalised recommendations