Cognition and cardiovascular comorbidities among older adults in primary care in West India

Multi-target drugs for Alzheimer's disease

Alzheimer's disease (AD), a leading cause of dementia, increasingly challenges our healthcare systems and society. Traditional therapies aimed at single targets have fallen short owing to the complex, multifactorial nature of AD that necessitates simultaneous targeting of various disease mechanisms for clinical success. Therefore, targeting multiple pathologies at the same time could provide a synergistic therapeutic effect. The identification of new disease targets beyond the classical hallmarks of AD offers a fertile ground for the design of new multi-target drugs (MTDs), and building on existing compounds have the potential to yield in successful disease modifying therapies. This review discusses the evolving landscape of MTDs, focusing on their potential as AD therapeutics. Analysis of past and current trials of compounds with multi-target activity underscores the capacity of MTDs to offer synergistic therapeutic effects, and the flourishing genetic understanding of AD will inform and inspire the development of MTD-based AD therapies.

Prevalence and risk factors of cognitive impairment in Chinese patients with hypertension: a systematic review and meta-analysis

Background

Cognitive impairment is prevalent in Chinese patients with hypertension; however, current evidence on prevalence and risk factors is required to be synthesized.

Objectives

This systematic review and meta-analysis aimed to evaluate the prevalence and risk factors of cognitive impairment in Chinese patients with hypertension.

Methods

Two reviewers independently searched PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, the Wanfang database, and the VIP database from their inception to 7 June 2023. The gray literature and the reference lists of the included studies were also retrieved manually. Moreover, we also independently performed the eligibility screening, data extraction, and data synthesis. The primary outcome was the prevalence of cognitive impairment in Chinese patients with hypertension, and the secondary outcomes were the risk factors for cognitive impairment in patients with hypertension. R (version 4.0.3) was used for data synthesis.

Results

In total, 82 studies involving 53,623 patients with hypertension were included in this meta-analysis. The pooled prevalence of cognitive impairment in patients with hypertension was 37.6% (95% CI: 33.2-42.2%). A total of 12 risk factors, including advanced age (r = -0.34, 95% CI: -0.45, -0.21), female sex (OR = 1.15, 95% CI: 1.01-1.32), BMI > 24 Kg/m2 (OR = 1.76, 95% CI: 1.04-3.00), lower educational level (OR = 2.01, 95% CI: 1.10-3.67), single status (OR = 1.63, 95% CI: 1.32-2.02), complications with diabetes (OR = 1.44, 95% CI: 1.14-1.80), coronary heart disease (OR = 1.49, 95% CI: 1.12-1.97), higher stage of hypertension [stage 3 vs. stage 1, OR = 3.08, 95% CI: 1.82-5.22; stage 2 vs. stage 1, OR = 1.83, 95% CI: 1.29-2.60], no regular physical activity (OR = 0.40, 95% CI: 0.21-0.77), higher levels of systolic blood pressure (r = -0.25, 95% CI: -0.42, -0.08), Hcy (r = -0.39, 95% CI: -0.63, -0.09), and IL-6 (r = -0.26, 95% CI: -0.48, -0.02) were detected.

Conclusion

Cognitive impairment is prevalent in Chinese patients with hypertension, and the increased prevalence was associated with several demographic characteristics, complicated disease, no regular physical activity, worse hypertension status (higher stages and SBP), and high levels of biomarkers. Therefore, more attention should be paid to the early identification and treatment of patients with hypertension who are at high risk for cognitive impairment in clinical practice. In addition, relevant risk factors should be controlled to reduce the incidence of cognitive impairment.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42023410437].

Feasibility and acceptability study of risk reduction approach for stroke prevention in primary care in Western India

Objectives

Stroke is among the leading cause of morbidity and mortality and prevention is the need of the hour. Risk assessment of stroke could be done at primary care. A study was hence planned to assess if an information, education, and communication (IEC) intervention module could be used to address risk factors of stroke among attendees of primary care in Western India.

Materials and Methods

Patients (>30 years) attending primary care center were enrolled (n = 215). Knowledge, attitude, and practice (KAP) questionnaire was administered at baseline and end line, and detailed diagnosis (hypertension and/diabetes, stroke, coronary artery disease, etc.) was noted from written records. A predesigned IEC module was administered about stroke, risk factors, and their prevention. Body mass index (BMI) and waist-to-hip ratio were taken before and after 16 weeks.

Results

A total of 215 participants (M: F = 85:130; mean age = 51.66 ± 13.32 years) had risk factors such as hypertension (26.7%), diabetes (32.5%), history of stroke (n = 3; = 1.39%), and 7.4% (16/215) had coronary artery disease. Before and after comparison of KAP scores indicated significant difference (62.23 ± 19.73 vs. 75.32 ± 13.03); P ≤ 0.0001). Change of waist-to-hip ratio occurred from baseline 0.91-0.9 (P ≤ 0.001). Comparison of the proportion of patients taking antihypertensives before and after IEC intervention was statistically significant (P < 0.05), indicating improvement in drug compliance. BMI comparison changed marginally (26.5 ± 4.7 vs. 26.2 ± 4.5) before and after but was not significant (P ≥ 0.05). The intervention was found to be feasible and acceptable.

Conclusion

IEC intervention appears to be a low-cost, feasible, and acceptable implementation model for addressing risk factors for stroke in primary care.