4/12/2024 0 Comments Moca test score bell curve7 Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) randomly allocated 5,926 participants meeting the ONTARGET inclusion criteria but intolerant to ACE inhibitors to either telmisartan (80 mg once daily) or placebo. 7- 12 Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) randomly allocated 25,620 participants with coronary artery disease, peripheral artery disease, cerebrovascular disease, or diabetes mellitus with end-organ damage to ramipril (10 mg once daily), telmisartan (80 mg once daily), or a combination of both. We included participants from six large international cardiovascular prevention RCTs. We calculated the prevalence of significant cognitive or functional impairment in different world regions, using widely accepted thresholds for cognitive or functional tests, and explored whether country-standardization changed the differences in these estimates between world regions. We then sought to determine if variation in the results of cognitive and functional tests between world regions could be explained by study, recruitment centre or individual level factors. We used data from a large cohort of participants with a history of cardiovascular disease or cardiovascular risk factors, in six international randomised controlled trials (RCTs) that assessed antihypertensive, antidiabetic and antithrombotic medications, to describe the variation in simple measures of cognition and function (activities of daily living) by world region. 5, 6 A better understanding of global variation in similar tests of cognition and function, and the sources of variation, would improve measurement, analysis, and interpretation of the results of multi-national studies of cognitive and functional impairment. Therefore, using the same assessment tools in all countries is preferable, but requires researchers to recognize and address sources of variation in measuring test performance such as educational attainment, familiarity with testing instruments and the applicability of the functional activities assessed to different regions. International standardization of measures of function would be needed for drug approval in each country, 3 although there are no generally agreed measures.Ĭulturally appropriate assessments designed to measure cognition or function in individual countries or regions could have internal consistency, 4 but they are difficult to use at scale or to aggregate between regions. 1, 2 Although they are important to people, these measures of function are hard to measure and standardize internationally. Although international studies of cardiovascular disease prevention usually measure the incidence of major adverse cardiovascular events, they rarely measure functional impairments, such as cognition or the ability to perform everyday activities.
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