Les troubles cognitifs d'origine vasculaire (TCV) sont des troubles cognitifs qui partagent entre eux une cause vasculaire presumee. Ils representent un groupe heterogene, d'etiologies diverses et augmentent avec l'âge. Une proportion relativement elevee de ces troubles cognitifs pourrait etre prevenue ou retardee. Bien que l'âge soit le facteur de risque le plus important, les facteurs de risques cardiovasculaires et les antecedents de maladies cardiovasculaires sont etablis comme etant des facteurs de risque d'un declin cognitif et de demence. L'effet preventif d'un traitement antihypertenseur sur le declin cognitif est maintenant bien etabli ; en revanche, l'effet du traitement des dyslipidemies sur la reduction du declin cognitif et la demence n'est pas concluant. Les strategies de depistage des TCV ne sont pas standardisees et des etudes sur du long terme sont necessaires pour etablir les conduites a tenir.
Objective: To investigate the association of overall mortality with the presence and extent of calcification in the very elderly. Design: Prospective study. Method: We investigated the association of CC (mitral annulus, aortic valve) and AC (abdominal aorta, carotid and femoral arteries) by ultrasonography, with all-cause mortality in a population of 331 elderly high-risk subjects (mean age ± standard deviation (SD): 86.8±6.9 years). After a mean follow-up of 378 days, 110 deaths occurred. Results: A simple calcification score, defined by the presence of CC and AC, was significantly associated with all-cause mortality (hazard ratio (HR) =1.47 per 1-unit, 95% confidential interval (CI): 1.08–1.99), independent of low plasma albumin, increased plasma glucose and creatinine, as well as low diastolic blood pressure. Moreover, AC showed negligible prognostic value with a high prevalence >89%, while CC significantly predicted overall mortality (HR=1.92, 95% CI: 1.28–2.87) at a prevalence of 36% [figure 1]. In another Cox regression, mitral annular calcification was proved to be a significant predictor of total mortality (HR=1.61, 95% CI: 1.02–2.54), independent of plasma albumin, glucose and creatinine, as well as low body mass index and previous CV events. Conclusions: The independent association between the extent of calcification and all-cause mortality is consistently significant in this frail oldest old population. AC presents a very high prevalence but a low predictive value, whereas in CC, prevalence is lower but predictive value is higher.
