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BackgroundAge-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions.MethodsAuthors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data.ResultsHypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive.ConclusionsAfter carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.

BackgroundThe etiology of cognitive impairment in heart failure (HF) is controversial and likely multifactorial. Physicians may hesitate to prescribe evidence-based HF medication because of concerns related to potential negative changes in cognition among a population that is already frequently impaired. We conducted a study to determine if prescription of evidence-based HF medications (specifically, β-blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blocking agents, diuretics, and aldosterone inhibitors) was associated with cognition in a large HF sample.MethodsA total of 612 patients completed baseline data collection for the Rural Education to Improve Outcomes in Heart Failure clinical trial, including information about medications. Global cognition was evaluated using the Mini-Cog.ResultsThe sample mean (SD) age was 66 (13) years, 58% were men, and 89% were white. Global cognitive impairment was identified in 206 (34%) of the 612 patients. Prescription of evidence-based HF medications was not related to global cognitive impairment in this sample. This relationship was maintained even after adjusting for potential confounders (eg, age, education, and comorbid burden).ConclusionPrescription of evidence-based HF medications is not related to low scores on a measure of global cognitive function in rural patients with HF.

Financial stress has been linked to an increased risk of metabolic syndrome, yet, it remains unclear whether suboptimal sleep duration and physical inactivity are the adaptive responses to financial stress or effect modifiers in the association between financial stress and metabolic syndrome. Hence, this study aims to examine whether physical activity and sleep duration mediate or moderate the bivariate association between financial stress and metabolic syndrome. A prospective secondary analysis was conducted using data from the Wisconsin Sleep Cohort Study (N = 445, mean [SD] age = 64 [7] years). Baseline moderation effect was examined using subgroup analysis with model constraints; prospective mediation model was examined using bias‐corrected bootstrap confidence intervals. Results indicate that participants with higher financial stress were less likely to meet physical activity and sleep recommendations. Baseline moderation analysis indicates that meeting current recommendations of sleep duration and physical activity attenuated the association between financial stress and metabolic syndrome. In the prospective mediation analysis, weekly physical activity levels partially mediated the relationship between financial stress and metabolic syndrome, but sleep duration did not mediate this relationship. In conclusion, the joint effect of optimal sleep duration and physical activity disassociates financial stress from the risk of metabolic syndrome. Future interventions addressing metabolic risk might achieve better outcomes if clinicians and researchers factor in the behavioral adaptation of physical inactivity in financially stressed adults (Clinical Trial Registration: NCT00005557). [ABSTRACT FROM AUTHOR]

Background: Living with chronic condition(s) is difficult, due in part to the complexities of effective disease self‐care. Self‐care has been considered a challenging process according to the literature which describes multiple barriers patients with chronic conditions experience. Resilience has the potential to buffer the adversities of daily self‐care and maintain physical and emotional well‐being. No systematic review and meta‐analysis have been conducted to synthesise and quantify the relationship between resilience and self‐care across chronic conditions. Aims: (1) To examine how the definitions and measurements of self‐care and resilience align with the middle‐range theory of self‐care of chronic illness (i.e. self‐care maintenance, self‐care monitoring, and self‐care management) and 3 Rs of resilience process from the society‐to‐cells framework (i.e. resistance, recovery and rebound) across different chronic conditions; and (2) to examine whether and the degree to which resilience is correlated with self‐care across different chronic conditions. Design: Systematic review and meta‐analysis, following PRISMA guidelines. Methods: PubMed, CINAHL, SocINDEX and PsychINFO were searched for quantitative studies published from January 2000 through July 2020. Descriptive data were summarised using numerical counting to provide an overview of the study characteristics. Definitions and measurements of self‐care and resilience were synthesised narratively based on self‐care and resilience theories. Numerical data with Pearson's product–moment correlation among observational studies were examined using meta‐analysis. Results: This review included 20 articles, involving 9,269 individuals across 11 chronic conditions. Despite self‐care and resilience being defined and operationalised in a variety of ways, most definitions shared some underlying core constructs. Meta‐analysis showed a positive relationship between resilience and self‐care across chronic conditions. Findings from interventional studies indicated a bidirectional relationship between resilience and self‐care. Conclusions: Overall, resilience was positively associated with self‐care in people with chronic conditions. Longitudinal and experimental studies are needed to better understand the causal relationship between resilience and self‐care. Relevant to clinical practice: Resilience has the potential to buffer the adversities of daily self‐care and maintain physical and emotional well‐being. The positive relationship between resilience and self‐care found in this review provides preliminary evidence for clinicians to not only focus on reducing barriers and risk factors of self‐care but also to improve or increase patients' resilience through various evidence‐based interventions. [ABSTRACT FROM AUTHOR]