Internal Med Medical News about Practice Guideline Risk Factors Vascular Diseases Cognition

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The inclusion of cognition in vascular risk factor clinical practice guidelines
Clinical Interventions in Aging, 11/03/09

Rockwood K et al. – Despite evidence that links cognitive impairment to vascular risk factors, only a minority of clinical practice guidelines for the treatment of vascular risk factors consider cognition as either an adverse outcome or as a factor to consider in treatment.

Exclusive Author Commentary
Kenneth Rockwood, 11/06/09

The reason to treat vascular risk factors is to avoid damage to target organs, including the brain. Conventionally, such damage has been conceived of as stroke, especially motoric strokes. Cognition is also affected by vascular risk factors, but for historical reasons, has received much less recognition. This paper shows that most vascular risk factor guidelines ignore the impact on cognition. It notes too that cognitive impairment in this at risk group might affect medication adherence – and thereby increase risk. Perhaps now that the Hypertension in the Very Elderly Trial data have drawn attention to cognition and hypertension, we might see a change. For now, however, we are left with the vicious cycle of cognition not being studied in trials, so that we have little data about it, so that it is ignored in evidence-based clinical practice guidelines. This is just one example of how “evidence based” often is indistinguishable from “evidence-biased”.