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Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use
INTRODUCTION: Although, on average, cognition declines with age, cognition in older adults is a dynamic process. Hypertension is associated with greater decline in cognition with age, but whether treatment of hypertension affects this is uncertain. Here, we modelled dynamics of cognition in relation...
Autores principales: | , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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Public Library of Science
2010
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909901/ https://www.ncbi.nlm.nih.gov/pubmed/20668673 http://dx.doi.org/10.1371/journal.pone.0011775 |
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author | Peters, Ruth Beckett, Nigel Beardmore, Robert Peña-Miller, Rafael Rockwood, Kenneth Mitnitski, Arnold Mt-Isa, Shahrul Bulpitt, Christopher |
author_facet | Peters, Ruth Beckett, Nigel Beardmore, Robert Peña-Miller, Rafael Rockwood, Kenneth Mitnitski, Arnold Mt-Isa, Shahrul Bulpitt, Christopher |
author_sort | Peters, Ruth |
collection | PubMed |
description | INTRODUCTION: Although, on average, cognition declines with age, cognition in older adults is a dynamic process. Hypertension is associated with greater decline in cognition with age, but whether treatment of hypertension affects this is uncertain. Here, we modelled dynamics of cognition in relation to the treatment of hypertension, to see if treatment effects might better be discerned by a model that included baseline measures of cognition and consequent mortality METHODOLOGY/PRINCIPAL FINDINGS: This is a secondary analysis of the Hypertension in the Very Elderly Trial (HYVET), a double blind, placebo controlled trial of indapamide, with or without perindopril, in people aged 80+ years at enrollment. Cognitive states were defined in relation to errors on the Mini-Mental State Examination, with more errors signifying worse cognition. Change in cognitive state was evaluated using a dynamic model of cognitive transition. In the model, the probabilities of transitions between cognitive states is represented by a Poisson distribution, with the Poisson mean dependent on the baseline cognitive state. The dynamic model of cognitive transition was good (R(2) = 0.74) both for those on placebo and (0.86) for those on active treatment. The probability of maintaining cognitive function, based on baseline function, was slightly higher in the actively treated group (e.g., for those with the fewest baseline errors, the chance of staying in that state was 63% for those on treatment, compared with 60% for those on placebo). Outcomes at two and four years could be predicted based on the initial state and treatment. CONCLUSIONS/SIGNIFICANCE: A dynamic model of cognition that allows all outcomes (cognitive worsening, stability improvement or death) to be categorized simultaneously detected small but consistent differences between treatment and control groups (in favour of treatment) amongst very elderly people treated for hypertension. The model showed good fit, and suggests that most change in cognition in very elderly people is small, and depends on their baseline state and on treatment. Additional work is needed to understand whether this modelling approach is well suited to the valuation of small effects, especially in the face of mortality differences between treatment groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT0012281 |
format | Text |
id | pubmed-2909901 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-29099012010-07-28 Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use Peters, Ruth Beckett, Nigel Beardmore, Robert Peña-Miller, Rafael Rockwood, Kenneth Mitnitski, Arnold Mt-Isa, Shahrul Bulpitt, Christopher PLoS One Research Article INTRODUCTION: Although, on average, cognition declines with age, cognition in older adults is a dynamic process. Hypertension is associated with greater decline in cognition with age, but whether treatment of hypertension affects this is uncertain. Here, we modelled dynamics of cognition in relation to the treatment of hypertension, to see if treatment effects might better be discerned by a model that included baseline measures of cognition and consequent mortality METHODOLOGY/PRINCIPAL FINDINGS: This is a secondary analysis of the Hypertension in the Very Elderly Trial (HYVET), a double blind, placebo controlled trial of indapamide, with or without perindopril, in people aged 80+ years at enrollment. Cognitive states were defined in relation to errors on the Mini-Mental State Examination, with more errors signifying worse cognition. Change in cognitive state was evaluated using a dynamic model of cognitive transition. In the model, the probabilities of transitions between cognitive states is represented by a Poisson distribution, with the Poisson mean dependent on the baseline cognitive state. The dynamic model of cognitive transition was good (R(2) = 0.74) both for those on placebo and (0.86) for those on active treatment. The probability of maintaining cognitive function, based on baseline function, was slightly higher in the actively treated group (e.g., for those with the fewest baseline errors, the chance of staying in that state was 63% for those on treatment, compared with 60% for those on placebo). Outcomes at two and four years could be predicted based on the initial state and treatment. CONCLUSIONS/SIGNIFICANCE: A dynamic model of cognition that allows all outcomes (cognitive worsening, stability improvement or death) to be categorized simultaneously detected small but consistent differences between treatment and control groups (in favour of treatment) amongst very elderly people treated for hypertension. The model showed good fit, and suggests that most change in cognition in very elderly people is small, and depends on their baseline state and on treatment. Additional work is needed to understand whether this modelling approach is well suited to the valuation of small effects, especially in the face of mortality differences between treatment groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT0012281 Public Library of Science 2010-07-26 /pmc/articles/PMC2909901/ /pubmed/20668673 http://dx.doi.org/10.1371/journal.pone.0011775 Text en Peters et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Peters, Ruth Beckett, Nigel Beardmore, Robert Peña-Miller, Rafael Rockwood, Kenneth Mitnitski, Arnold Mt-Isa, Shahrul Bulpitt, Christopher Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use |
title | Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use |
title_full | Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use |
title_fullStr | Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use |
title_full_unstemmed | Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use |
title_short | Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use |
title_sort | modelling cognitive decline in the hypertension in the very elderly trial [hyvet] and proposed risk tables for population use |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909901/ https://www.ncbi.nlm.nih.gov/pubmed/20668673 http://dx.doi.org/10.1371/journal.pone.0011775 |
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