Hypertension and the Risk of Dementia

Risk factors for dementia in the context of cardiovascular disease: A protocol of an overview of reviews

BACKGROUND

Dementia is a major public health priority. Although there is abundant evidence of an association between dementia and poor cardiovascular health, findings have been inconsistent and uncertain in identifying which factors increase dementia risk in those with cardiovascular disease. Indeed, multiple variables including sociodemographic, economic, health, lifestyle and education may indicate who is at higher vs. lower dementia risk and could be used in prediction modelling. Therefore, the aim of this review is to synthesise evidence on the key risk factors for dementia in those with a history of cardiovascular disease.

METHODS

This is an overview of reviews protocol, registered on PROSPERO (CRD42021265363). Four electronic databases including MEDLINE, EMBASE, PsycINFO, and the Cochrane Database of Systematic Reviews will be searched. Studies will be included if they are systematic reviews and/or meta-analyses that have investigated the risk of incident dementia (all-cause and subtypes including Alzheimer's disease and vascular dementia) in people with a history of coronary heart disease, heart failure, atrial fibrillation, hypertension, hyperlipidaemia, and vascular stiffness. Study selection will be completed by two independent researchers according to the eligibility criteria, and conflicts resolved by a third reviewer. References will be exported into Covidence for title and abstract sifting, full-text review, and data extraction. Methodological quality will be assessed using the AMSTAR-2 criteria and confidence of evidence will be assessed using the GRADE classification. This overview of reviews will follow PRISMA guidelines. If there is sufficient homogeneity in the data, the results will be pooled, and a meta-analysis conducted to determine the strength of association between each risk factor and incident all-cause dementia and its subtypes for each cardiovascular diagnoses separately.

DISCUSSION

We will create a comprehensive summary of the key risk factors linking cardiovascular diseases to risk of incident dementia. This knowledge is essential for informing risk predictive model development as well as the development of risk reduction and prevention strategies.

Hypertension and Its Associated Factors Among Long-Distance Truck Drivers in Ethiopia

Introduction

Hypertension is rising globally and is one of the leading causes of cardiovascular disease. It affects people of different groups; however, owing to a rise in a sedentary lifestyle it is more prevalent among long-distance truck drivers. However, the prevalence of hypertension and its associated factors among truck drivers in Ethiopia is not known. Therefore, this study aimed to determine the prevalence of hypertension and its associated factors among long-distance truck drivers in Ethiopia.

Methods

A cross-sectional study was conducted among 415 long-distance truck drivers selected by systematic random sampling technique at Modjo dry port from May 15 to 30, 2021. The data were collected and entered into Epi-data 4.6 then it was exported to SPSS version 25 for analysis. Descriptive statistics, bivariable, and multivariable logistic regression analyses were executed. The odds ratio with a 95% confidence interval was computed. In the final model, a variable with a p ≤ 0.05 was declared as a predictor of hypertension.

Results

The prevalence of hypertension among long-distance truck drivers in Ethiopia was 34.7%. The odds of hypertension was higher among drivers who were ≥45 years old [Adjusted odds ratio (AOR) = 4.32; 95% Confidence interval (CI): 2.16, 8.62], obese [AOR= 5.12; 95% CI: 1.33, 19.8], alcohol drinkers [AOR=3.05; 95% CI: 1.27, 7.31], and cigarette smokers [AOR= 3.74; 95% CI: 1.64, 8.51]. Drivers who had regular physical exercise were less likely [AOR=0.33; 95% CI: 0.17, 0.63] to have hypertension than drivers with no physical activity.

Conclusion

More than a third of the participants in Ethiopia had hypertension. Higher age, obesity, absence of rest between driving, short sleep duration, smoking, alcohol drinking, and physical inactivity were significantly associated with hypertension. Therefore, health education on lifestyle modifications, sleep habits, and the importance of rest breaks between driving should be considered to prevent hypertension and further complications.

Effect of Acupuncture on Blood Pressure and Metabolic Profile Among Patients With Essential Hypertension: Protocol of a Randomized Clinical Trial

Essential hypertension is a polygenic cardiovascular disease that is associated with maladaptive metabolic changes. Acupuncture as a non-pharmacologic intervention is used to lower blood pressure and improve metabolic dysfunction. However, such effects have not been clinically characterized. We will conduct a randomized clinical trial to evaluate the antihypertensive effect of acupuncture among patients with essential hypertension and determine the associated metabolic improvements. This study is a phase II, two-arm, randomized, sham-controlled trial (Trial registration: ChiCTR2100043737), in which biospecimens will be collected for metabolic profiling. A total of 64 patients with a clinical diagnosis of essential hypertension will be randomly assigned to either the acupuncture or the sham acupuncture group in a 1:1 ratio. All participants will receive 10 treatments over 4 weeks, with three sessions per week for the first 2 weeks and two sessions per week for the remaining weeks. The primary outcome is the change of the systolic and diastolic blood pressure measured by the 24-h ambulatory blood pressure monitoring from baseline to 4 weeks. Secondary outcomes include the circadian rhythm of blood pressure, sleep quality measured by the Insomnia Severity Index, cognitive function measured by the Montreal Cognitive Assessment, and others. Fasting blood serum and urine samples will be collected at baseline and 4 weeks for targeted and untargeted metabolomics analysis. We will use the mixed-effects model and other related bioinformatics approaches to analyze the clinical and metabolome data. This metabolomic-based trial will provide important clinical data regarding the efficacy of acupuncture for essential hypertension to better inform evidence-based care delivery for hypertension patients. Moreover, the findings will offer important insights into the mechanism of action of acupuncture for hypertension by revealing its effect on metabolism. The results of this study will be used to inform the design of a statistically powered, multicenter, randomized trial. We will publish the study findings in peer-reviewed journals. The ethical approval of this study has been reviewed and approved by the Sichuan Regional Ethics Review Committee on Traditional Chinese Medicine (ID: 2021KL-006). The outcomes of the trial will be disseminated through peer-reviewed publications.

Healthcare services relaxing natural selection may contribute to increase of dementia incidence

Ageing and genetic traits can only explain the increasing dementia incidence partially. Advanced healthcare services allow dementia patients to survive natural selection and pass their genes onto the next generation. Country-specific estimates of dementia incidence rates (all ages and 15-49 years old), Biological State Index expressing reduced natural selection (Is), ageing indexed by life expectancy e(65), GDP PPP and urbanization were obtained for analysing the global and regional correlations between reduced natural selection and dementia incidence with SPSS v. 27. Worldwide, Is significantly, but inversely, correlates with dementia incidence rates for both all ages and 15-49 years old in bivariate correlations. These relationships remain inversely correlated regardless of the competing contributing effects from ageing, GDP and urbanization in partial correlation model. Results of multiple linear regression (enter) have shown that Is is the significant predictor of dementia incidence among all ages and 15-49 years old. Subsequently, Is was selected as the variable having the greatest influence on dementia incidence in stepwise multiple linear regression. The Is correlated with dementia incidence more strongly in developed population groupings. Worldwide, reduced natural selection may be yet another significant contributor to dementia incidence with special regard to developed populations.

Preventive Measures against the Development of Dementia in Old Age

Dementia is a neurological condition characterized by numerous types of central nervous system diseases, which gradually deteriorates an individual’s reasoning, rational thinking, and judgment abilities. As a serious public health concern that currently affects more than 50 million older adults, dementia is one of the most significant causes of incapacity, disability, and dependency among older adults. As new cases are expected to increase exponentially in the next three decades, dementia, which is not a normal feature of healthy aging despite the fact that it generally affects older adults disproportionately, requires enormous management and care efforts due to its associated socioeconomic, psychological, and physical burdens that involve the patient, their caregivers, guardians, family members, and society at large. Presently, there is no cure for dementia; however, this condition could be prevented. This narrative review aimed to provide a broad overview of studies detailing the alternative lifestyle modification-centered preventive measures against dementia. A comprehensive search of key databases to find articles related to this topic revealed that participating in regular physical activities, healthy eating and dieting, avoiding all forms of smoking, avoiding air pollutants, halting or reducing alcohol consumption, exercising the mind and being socially dynamic, getting enough rest and establishing good sleeping habits, infection prevention, stress prevention, avoidance of injuries, preventing the effects of social isolation and lockdowns, continuing education, and depression prevention are protective measures against the development of dementia.

The relationship between isolated hypertension with brain volumes in UK Biobank

BACKGROUND

Hypertension is a well-established risk factor for cognitive impairment, brain atrophy, and dementia. However, the relationship of other types of hypertensions, such as isolated hypertension on brain health and its comparison to systolic-diastolic hypertension (where systolic and diastolic measures are high), is still relatively unknown. Due to its increased prevalence, it is important to investigate the impact of isolated hypertension to help understand its potential impact on cognitive decline and future dementia risk. In this study, we compared a variety of global brain measures between participants with isolated hypertension to those with normal blood pressure (BP) or systolic-diastolic hypertension using the largest cohort of healthy individuals.

METHODS

Using the UK Biobank cohort, we carried out a cross-sectional study using 29,775 participants (mean age 63 years, 53% female) with BP measurements and brain magnetic resonance imaging (MRI) data. We used linear regression models adjusted for multiple confounders to compare a variety of global, subcortical, and white matter brain measures. We compared participants with either isolated systolic or diastolic hypertension with normotensives and then with participants with systolic-diastolic hypertension.

RESULTS

The results showed that participants with isolated systolic or diastolic hypertension taking BP medications had smaller gray matter but larger white matter microstructures and macrostructures compared to normotensives. Isolated systolic hypertensives had larger total gray matter and smaller white matter traits when comparing these regions with participants with systolic-diastolic hypertension.

CONCLUSIONS

These results provide support to investigate possible preventative strategies that target isolated hypertension as well as systolic-diastolic hypertension to maintain brain health and/or reduce dementia risk earlier in life particularly in white matter regions.

The Association Between Diet and Cardio-Metabolic Risk on Cognitive Performance: A Cross-Sectional Study of Middle-Aged Australian Adults

Adherence to different dietary patterns has been linked to the development of cognitive decline; yet little is known about whether this relationship is present in middle age. The current study aimed to explore the relationship between different dietary patterns, cognitive performance, and potential cardio-metabolic mechanisms for this relationship. Participants were recruited using a diet screening tool to ensure that the cohort had a range of diet quality ranging from relatively poor to relatively healthy. In a sample of 141 middle-aged adults (age: M = 52.84 years, SD = 6.87 years), multiple 24 h diet recalls were collected and used to score adherence to the Mediterranean diet, dietary approaches to stop hypertension (DASH) diet, and Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet. Metabolic risk was assessed using the metabolic syndrome severity score (MetSSS) and arterial stiffness. Cognitive performance was assessed using the Swinburne University Computerized Cognitive Assessment Battery (SUCCAB). Adherence to the MIND diet was significantly related to Stroop Processing domain (β = 0.19, p = 0.035). None of the dietary patterns were significantly related to MetSSS or arterial stiffness. However, adherence to the DASH diet was significantly associated with two cardio-metabolic measures including lower augmentation index (β = -0.17, p = 0.032) and lowered cholesterol (β = -0.18, p = 0.041). Interestingly, two cardio-metabolic risk factors were also associated with better cognitive performance: MetSSS (β = 0.21, p = 0.010) and waist circumference (β = 0.22, p = 0.020). Together these findings suggest that diet in middle age may be important for cognitive functioning and cardio-metabolic risk. However, more research is needed in the form of randomized controlled trials to confirm the direction of these relationships.

The Role of Lipid Rafts and Membrane Androgen Receptors in Androgen’s Neurotoxic Effects

Sex differences have been observed in multiple oxidative stress–associated neurodegenerative diseases. Androgens, such as testosterone, can exacerbate oxidative stress through a membrane androgen receptor (mAR), AR45, localized to lipid rafts in the plasma membrane. The goal of this study is to determine if interfering with mAR localization to cholesterol-rich lipid rafts decreases androgen induced neurotoxicity under oxidative stress environments. We hypothesize that cholesterol-rich caveolar lipid rafts are necessary for androgens to induce oxidative stress generation in neurons via the mAR localized within the plasma membrane. Nystatin was used to sequester cholesterol and thus decrease cholesterol-rich caveolar lipid rafts in a neuronal cell line (N27 cells). Nystatin was applied prior to testosterone exposure in oxidatively stressed N27 cells. Cell viability, endocytosis, and protein analysis of oxidative stress, apoptosis, and mAR localization were conducted. Our results show that the loss of lipid rafts via cholesterol sequestering blocked androgen-induced oxidative stress in cells by decreasing the localization of mAR to caveolar lipid rafts.

Annual Incidence of Dementia from 2003 to 2018 in Metropolitan Seoul, Korea: A Population-Based Study

National dementia plans were applied in dementia support centers established in Seoul, Korea between 2007 and 2009. However, the annual incidence rates of dementia in Seoul have not been reported. We investigated this annual incidence and the characteristics of incident cases from 2003 to 2018. The customized research database of the Korean National Health Insurance Services was used. The annual crude and age-standardized incidence of dementia patients and their characteristics were analyzed. This study analyzed 108,596 incident dementia cases aged ≥60 years. The incidence rate increased from 2003 to 2011, including a rapid increment from 2007 to 2011. From 2011 to 2018, the crude (age-standardized) incidence per 105 person-years decreased from 641.51 (577.12) to 448.26 (361.23). The proportion of incident dementia cases was highest in the highest income group every year. However, the proportion of incident dementia cases in the lowest income group increased from 10.4% in 2003 to 25.8% in 2011. The annual incidence rate of dementia showed a sharp increase immediately after 2007, the year dementia support centers began to be introduced, and then stabilized after 2011. The characteristics of incident dementia cases have changed, including the proportion in the low-income group.

Cognitive impairment and the threat of dementia pandemic or the journey of hypertensive patients to self-care deficit

In the Czech Republic, due to the population aging, the prevalence of cognitive dysfunction is increasing. Researchers estimate that by 2050 the number of patients with dementia in the Czech Republic will more than double. Since dementia cannot be cured, it is important to prevent the cognitive dysfunction development by influencing modifiable risk factors. Arterial hypertension (AH) is one of the main risk factors for the development of cognitive dysfunction and dementia. Elevated blood pressure values in youth are associated with a higher risk of cognitive decline in middle age and with the development of dementia in old age. Blood pressure control in low-risk patients with stage I hypertension reduces the risk of dementia development, including Alzheimers disease. Therefore, improving the AH control in the population since younghood will be needed to influence the emerging cognitive dysfunction pandemic.

Acupuncture Treatment is Associated with Reduced Dementia Risk in Patients with Migraine: A Propensity-Score-Matched Cohort Study of Real-World Data

BACKGROUND

Migraine is a recurrent headache disease that has been identified as a risk factor for subsequent dementia. The present study collected data from Taiwan's National Health Insurance Research Database (NHIRD) to investigate the incidence of dementia in patients with migraine who did or did not concurrently receive acupuncture treatment.

METHODS

A 1:1 propensity score method was used to match an equal number of patients (N = 4813) in the acupuncture and nonacupuncture cohorts based on sex, age, migraine diagnosis year, index year, insurance amount, urbanization level, baseline comorbidities, and medication usage. We employed Cox proportional hazards models to evaluate the risk of dementia.

RESULTS

Patients with migraine who received acupuncture treatment were found to have a lower risk of dementia (adjusted hazard ratio [aHR] = 0.51, 95% CI = 0.40-0.65) than those who did not undergo acupuncture treatment. The cumulative incidence of dementia was significantly lower in the acupuncture cohort than in the nonacupuncture cohort (Log rank test, p < 0.001). This propensity score-matched cohort study demonstrated an association between acupuncture treatment and dementia development in patients with migraine in Taiwan.

CONCLUSION

The results suggest that acupuncture treatment significantly reduced the development of dementia in patients with migraine.

Trends and Gender Differences in Mental Disorders in Hospitalized Patients in Thailand

Previous studies have shown that gender differences play a substantial role in the influence of mental disorders. This study was designed to investigate gender differences in mental disorders by presenting odd ratio (OR) trends and cumulative effects over a period of 13 years in Thailand. This observational study used hospital data from the Ministry of Public Health on selected patients admitted to inpatient departments in public hospitals with mental disorders, according to ICD-10 cause groups from 2007 to 2019, counting from more than 1,90,000 cases in 2007 to more than 4,00,000 cases in 2019. Data were collected from the Thailand Ministry of Public Health website. The results indicate that compared to women, men were positively related to five mental disorders revealed by the OR and the ratio per 100,000 population (mean and SD): psychoactive alcohol use (OR = 7.31-9.07, 271.19 (59.26)), substance abuse (OR = 5.06-7.82, 59.25 (33.71)), schizophrenia (OR = 1.64-1.93, 108.32 (19.62)), mental retardation (OR = 1.15-1.58, 10.64 (1.88)), and other mental and behavioral disorders (OR = 1.10-1.55, 70.67 (22.75)). Three mental disorders in men were found to be negatively related: neurotic and related disorders (OR=.34-.46, 27.98 (3.26)), mood (affective) disorders (OR = .44-.56, 31.91 (9.59)), and dementia (OR = .78-10.82, 13.75 (2.73)). Gender can become a key biological element that contributes to the dissimilarity of mental illness. Preventive care for men and women should, therefore, be prioritized for health conditions separately. More specifically, screening and detection, and providing appropriate intervention.

[The usefulness of a questionnaire during medical examinations for older subjects in evaluating frailty: Utilization in clinical practice]

AIM

The late-stage medical care system for older people provides medical examinations, including questionnaires for frailty. We examined whether or not this approach is useful in clinical practice.

METHODS

We used this questionnaire for the screening of frailty as follows: according to the manual prepared by the Japan Geriatrics Society, each question was classified as concerning oral (Q4, 5), physical (Q6-9), cognitive (Q10, 11), or social (Q13-15) frailty. Each frailty was defined if there was at least one negative answer in each question. The grip power and skeletal muscle index (SMI) according to a bioelectrical impedance analysis were also evaluated. Subjects who showed a reduced grip strength and SMI were defined as having sarcopenia, and those who showed only a reduced grip strength were defined as having possible sarcopenia.

RESULTS

One hundred and seventy-one subjects aged 81.0±4.2 years old (63.1% female) were enrolled. A total of 12.3% of subjects showed sarcopenia, and 17.5% showed possible sarcopenia. The prevalence of physical, cognitive, and social frailties was associated with sarcopenia. Oral frailty, defined as having decreased swallowing and mastication functions (Q4 and 5), was significantly related to sarcopenia. Physical frailty was associated with age. In patients with hypertension, a low incidence of cognitive frailty was found. Social frailty was related to a decreased body weight.

CONCLUSIONS

A questionnaire during medical examinations for older subjects may be useful for screening various frailties and may lead to promotion of the preventive care activities in the community. Further studies are needed to elucidate the relationship between each type of frailty and background characteristics.

The Impact of Cognitive Function on the Effectiveness and Safety of Intensive Blood Pressure Control for Patients With Hypertension: A post-hoc Analysis of SPRINT

Background: Poor cognitive function can predict poor clinical outcomes. Intensive blood pressure control can reduce the risk of cardiovascular diseases and all-cause mortality. In this study, we assessed whether intensive blood pressure control in older patients can reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality for participants in the Systolic Blood Pressure Intervention Trial (SPRINT) with lower or higher cognitive function based on the Montreal Cognitive Assessment (MoCA) cut-off scores.

Methods: The SPRINT evaluated the impact of intensive blood pressure control (systolic blood pressure <120 mmHg) compared with standard blood pressure control (systolic blood pressure <140 mmHg). We defined MoCA score below education specific 25th percentile as lower cognitive function. And SPRINT participants with a MoCA score below 21 (<12 years of education) or 22 (≥12 years of education) were having lower cognitive function, and all others were having higher cognitive function. The Cox proportional risk regression was used to investigate the association of treatment arms with clinical outcomes and serious adverse effects in different cognitive status. Additional interaction and stratified analyses were performed to evaluate the robustness of the association between treatment arm and stroke in patients with lower cognitive function.

Results: Of the participants, 1,873 were having lower cognitive function at baseline. The median follow-up period was 3.26 years. After fully adjusting for age, sex, ethnicity, body mass index, smoking, systolic blood pressure, Framingham 10-year CVD risk score, aspirin use, statin use, previous cardiovascular disease, previous chronic kidney disease and frailty status, intensive blood pressure control increased the risk of stroke [hazard ratio (HR) = 1.93, 95% confidence interval (CI): 1.04–3.60, P = 0.038)] in patients with lower cognitive function. Intensive blood pressure control could not reduce the risk of composite cardiovascular outcomes (HR = 0.81, 95%CI: 0.59–1.12, P = 0.201) and all-cause mortality (HR = 0.93, 95%CI: 0.64–1.35, P = 0.710) in lower cognitive function group. In patients with higher cognitive function, intensive blood pressure control led to significant reduction in the risk of stroke (HR = 0.55, 95%CI: 0.35–0.85, P = 0.008), composite cardiovascular outcomes (HR = 0.68, 95%CI: 0.56–0.83, P < 0.001) and all-cause mortality (HR = 0.62, 95%CI: 0.48–0.80, P < 0.001) in the fully adjusted model. Additionally, after the full adjustment, intensive blood pressure control increased the risk of hypotension and syncope in patients with lower cognitive function. Rates of hypotension, electrolyte abnormality and acute kidney injury were increased in the higher cognitive function patients undergoing intensive blood pressure control.

Conclusion: Intensive blood pressure control might not reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality in patients with lower cognitive function.

Chronic Renin-Angiotensin System Activation Induced Neuroinflammation: Common Mechanisms Underlying Hypertension and Dementia?

Hypertension is a major risk factor for the pathogenesis of vascular dementia and Alzheimer's disease. Chronic activation of the renin-angiotensin system (RAS) contributes substantially to neuroinflammation. We propose that neuroinflammation arising from chronic RAS activation can initiate and potentiate the onset of hypertension and related dementia. Neuroinflammation induced by chronic activation of the RAS plays a key role in the pathogenesis of dementia. Increased levels of pro-inflammatory cytokines tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and transforming growth factor (TGF)-β have been reported in brain tissue of vascular dementia patients and animal models of vascular dementia induced by either angiotensin II infusion or transverse aortic coarctation. It is proposed that neuronal cell death and synaptic dysfunction induced by neuroinflammation lead to cognitive impairment in dementia. The neuroprotective RAS pathway, regulated by angiotensin-converting enzyme 2 (ACE2) which converts angiotensin II into angiotensin-(1-7), can attenuate hypertension and dementia. Furthermore, the use of anti-hypertensive medications in preventing dementia or cognitive decline in hypertensive patients and animal models of dementia have mostly been beneficial. Current evidence suggests a strong link between RAS induced neuroinflammation and the onset of hypertension and dementia, which warrants further investigation. Strategies to counteract an overactive RAS and enhance the neuroprotective arm of the RAS may help prevent or improve cognitive impairment associated with hypertension.

Diet May Moderate the Relationship Between Arterial Stiffness and Cognitive Performance in Older Adults

BACKGROUND

Cognitive decline is influenced by various factors including diet, cardiovascular disease, and glucose control. However, the combined effect of these risk factors on cognitive performance is yet to be fully understood.

OBJECTIVE

The current study aimed to explore the inter-relationship between these risk factors and cognitive performance in older adults at risk of future cognitive decline.

METHODS

The sample comprised 163 (Age: M = 65.23 years, SD = 6.50) participants. Food Frequency Questionnaire data was used to score diet quality and adherence to the Western Style Diet (WSD) and Prudent Style Diet (PSD). Glucose control was gauged by serum levels of glycated hemoglobin (HbA1c) and arterial stiffness was measured using carotid to femoral pulse wave velocity. Cognitive performance was assessed using two subtests of the Swinburne University Computerized Cognitive Assessment Battery (SUCCAB) and Rey's Verbal Learning Test (RVLT).

RESULTS

Diet quality, adherence to the WSD or PSD, and glucose control were not significantly related to cognitive outcomes. However, a significant negative association was found between arterial stiffness and the spatial working memory subtest of SUCCAB (β= -0.21, p <  0.05). Arterial stiffness also significantly interacted with the PSD to impact total recall (F change (1,134) = 5.37, p <  0.05) and the composite score of RVLT (F change (1,134) = 4.03, p <  0.05).

CONCLUSION

In this sample of older adults at risk of cognitive decline, diet alone was not found to predict cognitive performance; however, it was found to moderate the relationship between arterial stiffness and cognition.

Relationship between Arterial Hypertension with Cognitive Performance in Elderly. Systematic Review and Meta-Analysis

Background: Previous systematic reviews report that arterial hypertension (AHT) is associated with lower performance in cognition in the elderly. However, some studies show that with higher blood pressure, a better cognitive performance is obtained. Objective: The aim of this study was to determine the relationship between AHT with cognitive performance in the elderly. Methods: the review involved a search on PubMed, Scopus and PsycINFO databases from January 1990 to March, 2020 to identify the relationship among AHT and cognitive performance in older people. Results: 1170 articles were identified, 136 complete papers were reviewed, a qualitative analysis of 26 studies and a quantitative analysis of eight studies were carried out. It was found that people with AHT have a lower performance in processing speed SMD = 0.40 (95% CI: 0.25, 0.54), working memory SMD = 0.28 (95% CI: 0.15, 0.41) in short-term memory and learning SMD = −0.27 (95% CI: −0.37, −0.17) and delayed recall SMD = −0.20 (95% CI: −0.35, −0.05). Only one study found that higher blood pressure was associated with better memory performance. Conclusion: Our results suggest that high blood pressure primarily affects processing speed, working memory, short-term memory and learning and delayed recall.

Vascular Dementia and Underlying Sex Differences

Vascular dementia (VaD) is the second most common form of dementia after Alzheimer's disease (AD); where Alzheimer's accounts for 60-70% of cases of dementia and VaD accounts for 20% of all dementia cases. VaD is defined as a reduced or lack of blood flow to the brain that causes dementia. VaD is also known occasionally as vascular contributions to cognitive impairment and dementia (VCID) or multi-infarct dementia (MID). VCID is the condition arising from stroke and other vascular brain injuries that cause significant changes to memory, thinking, and behavior, and VaD is the most severe stage while MID is produced by the synergistic effects caused by multiple mini strokes in the brain irrespective of specific location or volume. There are also subtle differences in the presentation of VaD in males and females, but they are often overlooked. Since 1672 when the first case of VaD was reported until now, sex and gender differences have had little to no research done when it comes to the umbrella term of dementia in general. This review summarizes the fundamentals of VaD followed by a focus on the differences between sex and gender when an individual is diagnosed. In addition, we provide critical evidence concerning sex and gender differences with a few of the main risk factors of VaD including pre-existing health conditions and family history, gene variants, aging, hormone fluctuations, and environmental risk factors. Additionally, the pharmaceutical treatments and possible mitigation of risk factors is explored.

Intestinal Barrier Dysfunction Exacerbates Neuroinflammation via the TLR4 Pathway in Mice With Heart Failure

Aims

The present study aimed to investigate alterations in neuroinflammation after heart failure (HF) and explore the potential mechanisms.

Methods

Male wild-type (WT) and Toll-like receptor 4 (TLR4)-knockout (KO) mice were subjected to sham operation or ligation of the left anterior descending coronary artery to induce HF. 8 weeks later, cardiac functions were analyzed by echocardiography, and intestinal barrier functions were examined by measuring tight junction protein expression, intestinal permeability and plasma metabolite levels. Alterations in neuroinflammation in the brain were examined by measuring microglial activation, inflammatory cytokine levels and the proinflammatory signaling pathway. The intestinal barrier protector intestinal alkaline phosphatase (IAP) and intestinal homeostasis inhibitor L-phenylalanine (L-Phe) were used to examine the relationship between intestinal barrier dysfunction and neuroinflammation in mice with HF.

Results

Eight weeks later, WT mice with HF displayed obvious increases in intestinal permeability and plasma lipopolysaccharide (LPS) levels, which were accompanied by elevated expression of TLR4 in the brain and enhanced neuroinflammation. Treatment with the intestinal barrier protector IAP significantly attenuated neuroinflammation after HF while effectively increasing plasma LPS levels. TLR4-KO mice showed significant improvements in HF-induced neuroinflammation, which was not markedly affected by intestinal barrier inhibitors or protectors.

Conclusion

HF could induce intestinal barrier dysfunction and increase gut-to-blood translocation of LPS, which could further promote neuroinflammation through the TLR4 pathway.

Effects of Antihypertensive Drugs on Cognitive Function in Elderly Patients with Hypertension: A Review

Hypertension is a common comorbidity that contributes to the development of various cardiovascular disorders in elderly patients. Moreover, hypertension has been associated with cognitive decline and dementia. Cognitive impairment leads to increased morbidity and mortality in elderly patients with hypertension. However, previous studies investigating the association between blood pressure (BP), BP variability (BPV), and antihypertensive drug use and the risk of cognitive impairment in elderly patients with hypertension have reported inconsistent findings. Given the global burden of hypertension, the aging population, and the low quality of life associated with cognitive impairment, a more comprehensive understanding of the association between hypertension and cognitive decline is needed. In this review, we summarized the current preclinical evidence and clinical research regarding the association of BP control, BPV, and antihypertensive drug use and cognitive function. We particularly focused on the differences among categories of antihypertensive drugs. We concluded that the correlation of BP and risk of cognitive function is non-linear and dependent on a patient's age. Intensive BP control is generally not recommended, particularly for the oldest-old. Increased BPV and characteristics of orthostatic hypotension in the elderly also increase the risk of cognitive decline. The current evidence does not support one category of antihypertensive drugs as superior to others for preventing dementia in elderly patients with hypertension.

Haemodynamic impairment along the Alzheimer's disease continuum

BACKGROUND AND PURPOSE

Alzheimer's disease (AD) is considered a clinical and biological continuum identified via cerebrospinal fluid (CSF) or imaging biomarkers. Chronic hypoperfusion is held as one of the main features of Alzheimer's disease, as part of the processes causing neuronal degeneration. The mechanism responsible for such condition is still debated, although recently a direct connection with amyloid peptides has been shown. Here the aim was to investigate whether measures of hypoperfusion change along the AD continuum.

METHODS

Seventy patients with mild AD were recruited and stratified according to their CSF biomarker profile-as indicated by the National Institute on Aging and Alzheimer's Association research framework-into patients with either isolated amyloid pathology (A+T-) or full-blown AD (A+T+), and further layered according to apolipoprotein E genotype. After evaluation of vascular risk factors, a transcranial Doppler was performed on each patient, to evaluate mean flow velocity and pulsatility index in the middle cerebral artery, and to calculate the breath-holding index. Patients were compared to a cohort of 17 healthy controls.

RESULTS

The breath-holding index was reduced in the AD continuum and was inversely correlated to CSF amyloid β42 levels. Such correlation was stronger in the A+T+ than in the A+T- group, and unexpectedly reached statistical significance only in the E3 and not in the E4 genotype carriers.

CONCLUSIONS

These results suggest a tight and effective relationship between amyloid β42, vascular hypoperfusion, cerebrovascular reactivity and epsilon genotype.

The link between nutrition and Alzheimer's disease: from prevention to treatment

Alzheimer's disease (AD) is the most common cause of dementia. To date, there is no effective pharmacological strategy to slow or stop disease progression. In this context, multiple alternative therapeutic strategies have been investigated for AD. This review addresses the potential role of nutrition interventions in AD prevention and treatment. Nutritional strategies for AD have been based on four pillars: maintaining a healthy weight (i.e., prevention and/or treatment of obesity, especially in midlife and prevention of weight loss in the later stages of AD); correction of nutritional deficiencies; adequate consumption of micronutrients (vitamins and minerals), especially those implicated in the pathways of AD pathophysiology; and microbiota modulation.

Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension

BACKGROUND AND OBJECTIVE

White matter lesions (WMLs) are imaging changes in MRI of cerebral small vessel disease associated with vascular risk factors, increasing the risk of dementia, depression, and stroke. Aldosterone (ALD) or activation of mineralocorticoid receptor (MR) causes cerebrovascular injury in a mouse model. We aimed to analyze the relationship between ALD and WMLs in a population with hypertension.

METHODS

We conducted a retrospective review of all patients screened for causes of secondary hypertension. We enrolled 547 patients with WMLs and matched these to controls without WMLs at a 1:1 ratio. White matter lesion load was assessed by using a modified Scheltens' scale.

RESULTS

Among the analytic sample (N = 1,094) with ages ranging from 30 to 64 years, 62.2% were male. We divided plasma ALD concentration (PAC), plasma renin activity (PRA), and ALD-renin ratio (ARR) into the third tertile (Q3), second tertile (Q2), and first tertile (Q1). We also analyzed them simultaneously as continuous variables. Multivariate logistic regression analysis showed that participants in Q3 (>17.26 ng/dl) of PAC (OR 1.59, 95% CI 1.15, 2.19), Q3 (<0.80 ng/dl) of PRA (OR 2.50, 95% CI 1.81, 3.44), and Q3 (>18.59 ng/dl per ng/ml*h) of ARR (OR 2.90, 95% CI 2.10, 4.01) had a significantly higher risk of WMLs than those in Q1 (<12.48) of PAC, Q1 (>2.19) of PRA, and Q1 (<6.96) of ARR. In linear regression analysis, we separately analyzed the correlation between the modified Scheltens' scale score and log(PAC) (β = 2.36; 95% CI 1.30, 3.41; p < 0.001), log(PRA) (β = -1.76; 95% CI -2.09, -1.43; p < 0.001), and log(ARR) (β = 1.86; 95% CI 1.55, 2.17; p < 0.001), which were all significantly correlated with white matter lesion load, after adjusting for confounding factors. Simple mediation analyses showed that systolic blood pressure (SBP) or diastolic blood pressure (DBP) mediated -3.83% or -2.66% of the association between PAC and white matter lesion load, respectively. In stratified analyses, there was no evidence of subgroup heterogeneity concerning the change in the risk of WMLs (p > 0.05 for interaction for all).

CONCLUSION

Higher PAC, especially in PAC >17.26 ng/dl, increased the risk of WMLs. PAC was positively associated with white matter lesion load independent of SBP or DBP.

Hypertension and Hypercholesterolemia Modify Dementia Risk in Relation to APOEɛ4 Status

BACKGROUND

There is significant interest in understanding the role of modifiable vascular risk factors contributing to dementia risk across age groups.

OBJECTIVE

Risk of dementia onset was assessed in relation to vascular risk factors of hypertension and hypercholesterolemia among cognitively normal APOEɛ4 carriers and non-carriers.

METHODS

In a sample of prospectively characterized longitudinal cohort from the National Alzheimer's Coordinating Center database, 9,349 participants met criteria for normal cognition at baseline, had a CDR-Global (CDR-G) score of zero, and had concomitant data on APOEɛ4 status and medical co-morbidities including histories of hypertension and hypercholesterolemia. Multivariable Cox proportional hazards models adjusted for well-known potential confounders were used to compare dementia onset among APOEɛ4 carriers and non-carriers by young (≤65 years) and old (> 65 year) age groups.

RESULTS

519 participants converted to dementia within an average follow up of 5.97 years. Among older APOEɛ4 carriers, hypercholesterolemia was related to lower risk of dementia (HR (95% CI), 0.68 (0.49-0.94), p = 0.02). Among older APOEɛ4 non-carriers, hypertension was related to higher risk of dementia (HR (95% CI), 1.44 (1.13-1.82), p = 0.003). These results were corroborated among a subset with autopsy data characterizing underlying neuropathology. Among younger participants, vascular risk factors did not impact dementia risk, likely from a lower frequency of vascular and Alzheimer's as etiologies of dementia among this cohort.

CONCLUSION

A history of hypercholesterolemia related to a lower risk of dementia among older APOEɛ4 carriers, while hypertension related to a higher risk of dementia among older APOEɛ4 non-carriers.

Glia-Driven Neuroinflammation and Systemic Inflammation in Alzheimer's Disease

The neuroinflammatory hypothesis of Alzheimer's disease (AD) was proposed more than 30 years ago. The involvement of the two main types of glial cells microglia and astrocytes, in neuroinflammation, was suggested early on. In this review, we highlight that the exact contributions of reactive glia to AD pathogenesis remain difficult to define, likely due to the heterogeneity of glia populations and alterations in their activation states through the stages of AD progression. In the case of microglia, it is becoming apparent that both beneficially and adversely activated cell populations can be identified at various stages of AD, which could be selectively targeted to either limit their damaging actions or enhance beneficial functions. In the case of astrocytes, less information is available about potential subpopulations of reactive cells; it also remains elusive whether astrocytes contribute to the neuropathology of AD by mainly gaining neurotoxic functions or losing their ability to support neurons due to astrocyte damage. We identify L-type calcium channel blocker, nimodipine, as a candidate drug for AD, which potentially targets both astrocytes and microglia. It has already shown consistent beneficial effects in basic experimental and clinical studies. We also highlight the recent evidence linking peripheral inflammation and neuroinflammation. Several chronic systemic inflammatory diseases, such as obesity, type 2 diabetes mellitus, and periodontitis, can cause immune priming or adverse activation of glia, thus exacerbating neuroinflammation and increasing risk or facilitating the progression of AD. Therefore, reducing peripheral inflammation is a potentially effective strategy for lowering AD prevalence.

Genetic risk of dementia modifies obesity effects on white matter myelin in cognitively healthy adults

APOE-ε4 is a major genetic risk factor for late-onset Alzheimer's disease that interacts with other risk factors, but the nature of such combined effects remains poorly understood. We quantified the impact of APOE-ε4, family history (FH) of dementia, and obesity on white matter (WM) microstructure in 165 asymptomatic adults (38-71 years old) using quantitative magnetization transfer and neurite orientation dispersion and density imaging. Microstructural properties of the fornix, parahippocampal cingulum, and uncinate fasciculus were compared with those in motor and whole-brain WM regions. Widespread interaction effects between APOE, FH, and waist-hip ratio were found in the myelin-sensitive macromolecular proton fraction from quantitative magnetization transfer. Among individuals with the highest genetic risk (FH+ and APOE-ε4), obesity was associated with reduced macromolecular proton fraction in the right parahippocampal cingulum, whereas no effects were present for those without FH. Risk effects on apparent myelin were moderated by hypertension and inflammation-related markers. These findings suggest that genetic risk modifies the impact of obesity on WM myelin consistent with neuroglia models of aging and late-onset Alzheimer's disease.

Innovative Therapies and Nanomedicine Applications for the Treatment of Alzheimer's Disease: A State-of-the-Art (2017-2020)

The field of nanomedicine is constantly expanding. Since the first work dated in 1999, almost 28 thousand articles have been published, and more and more are published every year: just think that only in the last five years 20,855 have come out (source PUBMED) including original research and reviews. The goal of this review is to present the current knowledge about nanomedicine in Alzheimer’s disease, a widespread neurodegenerative disorder in the over 60 population that deeply affects memory and cognition. Thus, after a brief introduction on the pathology and on the state-of-the-art research for NPs passing the BBB, special attention is placed to new targets that can enter the interest of nanoparticle designers and to new promising therapies. The authors performed a literature review limited to the last three years (2017–2020) of available studies with the intention to present only novel formulations or approaches where at least in vitro studies have been performed. This choice was made because, while limiting the sector to nanotechnology applied to Alzheimer, an organic census of all the relevant news is difficult to obtain.

Cortical atrophy mediates the accumulating effects of vascular risk factors on cognitive decline in the Alzheimer's disease spectrum

There are increasing concerns regarding the association of vascular risk factors (VRFs) and cognitive decline in the Alzheimer's disease (AD) spectrum. Currently, we investigated whether the accumulating effects of VRFs influenced gray matter volumes and subsequently led to cognitive decline in the AD spectrum. Mediation analysis was used to explore the association among VRFs, cortical atrophy, and cognition in the AD spectrum. 123 AD spectrum were recruited and VRF scores were constructed. Multivariate linear regression analysis revealed that higher VRF scores were correlated with lower Mini-Mental State Examination scores and higher Alzheimer's Disease Assessment Scale-Cognitive Subscale scores, indicating higher VRF scores lead to severer cognitive decline in the AD spectrum. In addition, subjects with higher VRF scores suffered severe cortical atrophy, especially in medial prefrontal cortex and medial temporal lobe. More importantly, common circuits of VRFs- and cognitive decline associated with gray matter atrophy were identified. Further, using mediation analysis, we demonstrated that cortical atrophy regions significantly mediated the relationship between VRF scores and cognitive decline in the AD spectrum. These findings highlight the importance of accumulating risk in the vascular contribution to AD spectrum, and targeting VRFs may provide new strategies for the therapeutic and prevention of AD.

Effect of Combined Antihypertensive and Lipid-Lowering Therapies on Cognitive Function: A New Treatment Strategy?

Risk factors for cardiovascular disease such as hypertension and hyperlipidemia are associated with cognitive decline. However, there is still no clear evidence that the use of antihypertensive or lipid-lowering therapy can prevent or delay cognitive decline or development of dementia. To provide a reference for clinical treatment, we analyzed the potential mechanisms of cognitive dysfunction induced by hypertension and hyperlipidemia, the clinical research and controversy of antihypertensive and lipid-lowering therapies on cognitive function, and the clinical value of combined antihypertensive and lipid-lowering therapy. It is currently believed that hypertension and elevated blood cholesterol levels in middle-aged people may be related to cognitive impairment or dementia in the elderly. Some studies suggest that intensive antihypertensive or lipid-lowering therapies are better than standard antihypertensive or lipid-lowering therapy, yet further tests are needed to confirm their effects on cognitive function. Actively controlling potential risk factors from middle age may be important for Alzheimer's disease (AD) prevention.

Impact of the Severities of Glaucoma on the Incidence of Subsequent Dementia: A Population-Based Cohort Study

The aim of the present study was to survey the relationship between the severity of glaucoma and subsequent dementia using the National Health Insurance Research Database (NHIRD) in Taiwan. Subjects with glaucoma were selected into the study group after an exclusion process, and each subject in the study group was propensity score-matched to another non-glaucoma patient that constituted the control group. The Cox proportional hazard regression that considered multiple potential risk factors of dementia was used to yield the adjusted hazard ratios (aHR) of dementia in different severities of glaucoma. There were 1185 (5.63 percent) subjects in the study group and 1119 (5.32 percent) patients in the control group that developed dementia. After adjusting for multiple confounders, there were no differences in the rate of any dementia (aHR: 0.961, 95% CI: 0.886–1.043, p = 0.3443), vascular dementia (aHR: 0.928, 95% CI: 0.846–1.018, p = 0.1154), Alzheimer’s disease (aHR: 1.018, 95% CI: 0.761–1.362, p = 0.9025) or Parkinson’s disease (aHR: 1.021, 95% CI: 0.886–1.176, p = 0.7744) between the study and the control groups. Regarding the disease severity of glaucoma, no difference was found in any type of dementia whether the glaucoma patients received less than two medical treatments, received more than two medical treatments, received drainage surgeries or received destructive surgeries. In conclusion, the different severities of glaucoma do not alter the incidence of subsequent dementia.