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Explanation on the pathophysiology of Dementia/ Alzheimer's.

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Explanation on the pathophysiology of Dementia/ Alzheimer's.

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What are dementia and Alzheimer's | Mental health | NCLEX-RN | Khan Academy

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Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment.

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Explanation on the pathophysiology on Hypertension.

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Explanation on the pathophysiology on Hypertension.

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Hypertension and Risk of Dementia Paper

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Controlling Blood Pressure later in life reduce the risk as well?

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Controlling Blood Pressure later in life reduce the risk as well?

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Heart Health

Everyone talks about the importance of treating high blood pressure, the "silent killer." And everybody knows that untreated high blood pressure can lead to heart attacks and strokes. But can treating high blood pressure reduce your risk of cognitive impairment and dementia?

High blood pressure is a risk factor for cognitive impairment and dementia

Cognition encompasses thinking, memory, language, attention, and other mental abilities. Researchers have known for many years that if you have high blood pressure, you have a higher risk of developing cognitive impairment and dementia. However, just because high blood pressure is a risk factor, it does not necessarily mean that lowering high blood pressure will lower your risk. Many things in health and science correlate without one causing the other (my favorite is the correlation between the drop in birth rate and the decline in the stork population). Thus, randomized, double-blind, controlled studies are needed to answer this question.

Prior studies have not provided clear answers

There have, in fact, been a lot of these studies. The most recent relevant study is the SPRINT-MIND study, designed to measure the effects of lowering high blood pressure on dementia and/or mild cognitive impairment. This study was so successful at reducing the risk of mild cognitive impairment by lowering high blood pressure that it ended early, because the data and safety monitoring board felt that it was unethical to continue the control group. However, the dementia endpoint had not yet reached statistical significance - likely because of this early termination. Thus, while the study succeeded in one sense, it ultimately concluded that treating systolic blood pressure to below 120 mmHg (versus lower than 140 mmHg) did not reduce risk of dementia.

A new analysis of many studies

Because SPRINT-MIND and many other prior studies have not clearly shown whether lowering our high blood pressure can reduce our risk of cognitive impairment and dementia, meta-analyses are needed to answer this question. Researchers in Ireland looked at data from 14 studies comprising almost 100,000 participants, followed over an average of more than four years. They found that older individuals (average age 69) who lowered their blood pressure are slightly less likely to develop dementia or cognitive impairment (7.0% versus 7.5%). Thus, the answer is: Yes! Lowering high blood pressure will lower our risk of dementia and cognitive impairment.

The relationship between high blood pressure and dementia

So, how does lowering high blood pressure reduce our risk of cognitive impairment and dementia? Most people who have dementia don't have just a single cause. Two or even three different problems in the brain cause their cognitive impairment and lead to their decline in function. One study estimates that the fraction of dementia risk attributable to cerebrovascular disease - that is, strokes - was nearly 25% in people who developed significant memory loss late in life. These researchers also found that the dementia risk attributable to Alzheimer's disease was considerably higher, nearly 40%.

My reading of the literature is that lowering blood pressure reduces dementia risk because it reduces the risk of stroke. It's the strokes - not high blood pressure by itself - that cause cognitive impairment. Note, however, that the strokes may be so tiny that one doesn't even know that they have them. But developing a lot of these tiny strokes (or a few big ones) will greatly increase our risk of dementia.

Optimal blood pressure for optimal brain health

Okay, but what's considered a healthy blood pressure from the perspective of the brain? The SPRINT-MIND study answers that question: people are less likely to develop mild cognitive impairment if their systolic blood pressure is lower than 120 mm Hg compared to the control condition of between 120 and 140 mm Hg. Thus, for optimal brain health, it's best to keep your systolic blood pressure below 120 mm Hg - at least according to the SPRINT-MIND study.

The bottom line

The take-home message is clear: You can reduce your risk of cognitive impairment and dementia by lowering your systolic blood pressure to less than 120 mm Hg, preferably with aerobic exercise, a Mediterranean diet, and a healthy weight, and by adding medications if those lifestyle changes alone are not sufficient.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Can controlling blood pressure later in life reduce risk of dementia? - Harvard Health

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An analysis of multiple studies looking at the relationship between high blood pressure and cognitive health -- abilities like thinking, memory, and attention -- found that older people who lower high blood pressure are slightly less likely to develop cognitive impairment or dementia.

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How lowering your blood pressure could reduce your risk of dementia

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Research finds link between blood pressure and dementia

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Controlling High Blood Pressure reduce Dementia and Alzheimer's?

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Controlling High Blood Pressure reduce Dementia and Alzheimer's?

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Treating high blood pressure with medication not only improves older adults' cardiovascular health, but also can reduce their risk of dementia and Alzheimer's disease, according to a thorough examination of long-term data from four countries.

A global team of scientists cross-referenced data from six large, longitudinal studies that tracked the health of over 31,000 adults over age 55 across several years of follow-up. They found that treating high blood pressure - no matter with which type of antihypertensive drug - reduced dementia risk by 12% and the risk of developing Alzheimer's disease by 16%. The findings, coordinated by investigators in the Laboratory of Epidemiology and Population Science of the NIA Intramural Research Program, were published in Lancet Neurology.

This comprehensive look extends the evidence from the recent SPRINT MIND trial that showed lowering blood pressure levels reduced the risk for a combination of dementia and mild cognitive impairment. The scientists teamed up to analyze data from six comprehensive, community-based health studies conducted between 1987 and 2008 in the United States, France, Iceland and the Netherlands. They examined all five major types of blood pressure medications - ACE inhibitors, angiotensin II receptor blockers, beta-blockers, calcium channel blockers and diuretics - and found that the type of medication did not make a difference.

Participant data was divided into two groups - 15,537 people with high blood pressure and 15,553 people with normal blood pressure. In all, 1,741 diagnoses of Alzheimer's disease and 3,728 cases of other dementias developed over time. People who controlled their blood pressure with medicine were found to have the same risk for developing dementia as individuals with normal blood pressure who did not require medication.

The investigators were pleased to work with a deeper data pool than previous studies, allowing them to look at specific medication types used to keep blood pressure at safe levels. The expanded study also gave them much longer-term follow-up data, which were helpful to observe the gradual onset of dementia and Alzheimer's symptoms. The large group of people studied also factored in additional health conditions common to older adults, giving them a clearer picture of the multiple issues that come with aging that are typically seen by general physicians.

Still to be investigated is how long-term changes in blood pressure impacts dementia risk, and further research with more detailed information is needed on specific antihypertensive medications.

Together with the SPRINT MIND trial, this latest data adds to the evidence base that treating and reducing high blood pressure can also help reduce the risk of dementia. The researchers hope their findings add urgency to the need for better hypertension awareness among the rapidly growing global population of older adults, many of whom are at risk for developing high blood pressure or already have it but are not managing it properly.
This study was supported by the Alzheimer's Drug Discovery Foundation and the NIA Intramural Research Program. These activities relate to NIA's AD+ADRD Research Implementation Milestone 1.F, "Enable precision medicine research by supporting deep and longitudinal molecular endophenotyping of existing and new at-risk cohorts as well cohorts and/or individuals who resist disease despite high genetic risk."
Reference: Ding J, et al. Antihypertensive medications and risk for incident dementia and Alzheimer's disease: a meta-analysis of individual participant data from prospective cohort studies. Lancet Neurology. 2019;pii: S1474-4422(19)30393-X. doi: 10.1016/S1474-4422(19)30393-X.

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Further evidence that controlling high blood pressure can reduce dementia, Alzheimer's risk

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Treating high blood pressure with medication not only improves older adults' cardiovascular health, but also can reduce their risk of dementia and Alzheimer's disease, according to a thorough examination of long-term data from four countries. A global team of scientists cross-referenced data from six large, longitudinal studies that tracked the health of over 31,000 adults over age 55 across several years of follow-up.

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Hypertension and the risk of dementia occurring

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Hypertension and the risk of dementia occurring

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doi: 10.3389/fcvm.2020.00005.

Affiliation

¹ Hypertension & Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona (IDIBAPS), University of Barcelona, Barcelona, Spain.

Free PMC article

Cristina Sierra . Front Cardiovasc Med.

Free PMC article

doi: 10.3389/fcvm.2020.00005.

Affiliation

¹ Hypertension & Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona (IDIBAPS), University of Barcelona, Barcelona, Spain.

Abstract

Hypertension, particularly midlife high blood pressure, has been related to a higher risk of cognitive decline and dementia, including Alzheimer disease. However, these associations are complex and not fully elucidated. Cerebral small vessel disease emerges as one of the most important causes. Several observational studies have shown the potential beneficial role of antihypertensive treatment in preventing cognitive decline. However, randomized clinical trials (RCTs) have shown controversial results without proving nor disproving the association. On the other hand, in very elderly or frail people some studies have observed a relationship between low blood pressure and worse cognitive function. The optimal systolic and diastolic blood pressure values for protecting cognitive function, especially in elderly people, are not known.

Keywords: antihypertensive treatment; cognitive function; cognitive impairment; dementia; essential hypertension; high blood pressure.

Figures

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Cerebral small vessel disease, cognitive impairment and vascular dementia.

Sierra C. Sierra C. Panminerva Med. 2012 Sep;54(3):179-88. Panminerva Med. 2012. PMID: 22801435

References

Meschia JF, Bushnell CD, Boden-Albala B, Braun LY, Bravata DM, Chaturvedi S, et al. . Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. (2014) 45:3754-832. 10.1161/STR.0000000000000046 - DOI - PMC - PubMed

Sierra C, Coca A, Schiffrin EL. Vascular mechanisms in the pathogenesis of stroke. Curr Hypertens Rep. (2011) 13:200-7. 10.1007/s11906-011-0195-x - DOI - PubMed

Gorelick PB, Scuteri A, Black SE, DeCarli CH, Greenberg SM, Iadecola C, et al. . Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. (2011) 42:2672-713. 10.1161/STR.0b013e3182299496 - DOI - PMC - PubMed

Rouch L, Cestac P, Hanon O, Cool C, Helmer C, Bouhanick B, et al. . Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs. (2015) 29:113-30. 10.1007/s40263-015-0230-6 - DOI - PubMed

Qiu C, Winblad B, Fratiglioni L. The age dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. (2005) 4:487-99. 10.1016/S1474-4422(05)70141-1 - DOI - PubMed

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national center for biotechnology information

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Hypertension and the Risk of Dementia - PubMed

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Hypertension, particularly midlife high blood pressure, has been related to a higher risk of cognitive decline and dementia, including Alzheimer disease. However, these associations are complex and not fully elucidated. Cerebral small vessel disease emerges as one of the most important causes. Sever ...