Tünde Pál, Zoltan Preg, Enikő Nemes-Nagy, Robert Gabriel Tripon, Beáta Baróti and Márta Germán-Salló
Introduction: Hypertension is one of the most important modifiable risk factor related to cognitive decline and dementia. However, screening for cognitive dysfunction is not part of the routine clinical assessment.
Case presentation: In this report, we present the case of a 75 year old hypertensive male patient with new-onset atrial fibrillation, admitted to the Cardiovascular Rehabilitation Clinic Târgu Mureș. Apart from the routine clinical assessment, the evaluation of cognitive functions was performed with three different screening instruments which identified cognitive dysfunction. Depressive state was assessed with the shortened 13 items form of the Beck Depression Inventory BDI-13 (BDI-13) and it showed moderate depression which could influence the results of cognitive tests. Detection of cognitive impairment was followed by magnetic resonance imaging, which revealed not only hypertension specific microvascular impairment but also a sequelae of a former stroke in the territory of the left middle cerebral artery and a possible meningioma.
Conclusion: Screening for cognitive dysfunction in high-risk hypertensive patients can be easily performed and in several cases like ours, can unmask silent cerebrovascular pathologies, leading to prognostic and therapeutic consequences.
Márta Germán-Salló, Enikő Nemes-Nagy, Beáta Baróti, Robert Gabriel Tripon and Zoltán Preg
The current guidelines for the diagnosis and treatment of hypertension recommend screening for cognitive impairment in all hypertensive patients as part of the clinical assessment. However, the implementation of this recommendation in clinical practice is still unsatisfactory. We present the case of an elderly hypertensive female patient in order to highlight the importance of screening for cognitive impairment. A patient with a history of poorly controlled hypertension for the last 12 years and recently diagnosed with type 2 diabetes mellitus is admitted complaining of asthenia, dizziness, visual acuity impairment, and difficulty to remember recent information. Cardiovascular imaging showed 70% internal carotid artery stenosis in a neurologically asymptomatic patient. Cognitive testing showed mild cognitive impairment. Retinal imaging identified stage III hypertensive retinopathy accompanied by irreversible end-organ damage due to microvascular changes. At this point brain MRI was performed, which identified both macro- and microvascular brain lesions in the periventricular white matter and sequelae of a former ischemic stroke in the territory of the left posterior cerebral artery. Cognitive testing helped to unmask silent cerebrovascular disease in an otherwise oligosymptomatic hypertensive diabetic patient. Cognitive function testing should be introduced in routine clinical practice in order to help unmask silent cerebrovascular disease.
Márta Germán-Salló, Zoltan Preg, Dalma Bálint Szentendrey, Enikő Nemes-Nagy, Mihály Imre László, Zita Fazakas, Edith Simona Ianosi, Pál István Kikeli, Zoltán Ábrám and Péter Balázs
Objectives: To describe tobacco smoking habits, attitudes, second-hand smoke exposure, and training in cessation counselling at the University of Medicine Pharmacy, Sciences and Technology of Târgu-Mureș (UMPSTTM), as baseline data for the first Romanian university to implement a Smoke Free University Project.
Methods: A cross-sectional survey was administered in 2014 among dental students at UMPSTTM to explore their smoking habits, attitudes toward smoking and tobacco control policies, exposure to second-hand smoke, interest in quitting, and their knowledge about cessation counselling. We used core questions of the Global Health Professions Student Survey (GHPSS) and added specific items related to the Smoke Free University Project. Data were analysed by SPSS v22 software. We compared our results with those of the GHPSS Survey.
Results: 581 dental students, 73.1% of the target population (n=795), completed the questionnaire. 38.7% were current smokers. Approximately 1 in 5 (22.6%) current smokers admitted smoking inside university buildings, although 80.7% were aware of the smoking ban. 44.2% of current smokers plan to quit smoking. Nearly half of the students (48.9%) were exposed to secondhand smoke in their current homes, 78.1% in public places and 33.3% inside the university buildings. Only 21.0% of all participants received any formal training on how to help future patients quit.
Conclusions: Tobacco use prevalence was higher among future dentists than in the majority of respondents to the GHPSS. Changes in dental school education are needed to promote personal smoking cessation, as well as to educate dentists on how to support their future patients quitting.