151
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Walker KA, Power MC, Gottesman RF. Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review. Curr Hypertens Rep 2017; 19:24. [PMID: 28299725 DOI: 10.1007/s11906-017-0724-3] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypertension is a highly prevalent condition which has been established as a risk factor for cardiovascular and cerebrovascular disease. Although the understanding of the relationship between cardiocirculatory dysfunction and brain health has improved significantly over the last several decades, it is still unclear whether hypertension constitutes a potentially treatable risk factor for cognitive decline and dementia. While it is clear that hypertension can affect brain structure and function, recent findings suggest that the associations between blood pressure and brain health are complex and, in many cases, dependent on factors such as age, hypertension chronicity, and antihypertensive medication use. Whereas large epidemiological studies have demonstrated a consistent association between high midlife BP and late-life cognitive decline and incident dementia, associations between late-life blood pressure and cognition have been less consistent. Recent evidence suggests that hypertension may promote alterations in brain structure and function through a process of cerebral vessel remodeling, which can lead to disruptions in cerebral autoregulation, reductions in cerebral perfusion, and limit the brain's ability to clear potentially harmful proteins such as β-amyloid. The purpose of the current review is to synthesize recent findings from epidemiological, neuroimaging, physiological, genetic, and translational research to provide an overview of what is currently known about the association between blood pressure and cognitive function across the lifespan. In doing so, the current review also discusses the results of recent randomized controlled trials of antihypertensive therapy to reduce cognitive decline, highlights several methodological limitations, and provides recommendations for future clinical trial design.
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Affiliation(s)
- Keenan A Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446D 600 North Wolfe St., Baltimore, MD, 21287, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446D 600 North Wolfe St., Baltimore, MD, 21287, USA. .,Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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152
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Gil-Extremera B, Jiménez-López P, Mediavilla-García JD. Clinical trials. A pending subject. Rev Clin Esp 2017; 218:137-141. [PMID: 28774463 DOI: 10.1016/j.rce.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 01/13/2023]
Abstract
Clinical trials are essential tools for the progress of clinical medicine in its diagnostic and therapeutic aspects. Since the first trial in 1948, which related tobacco use with lung cancer, there have been more than 150,000 clinical trials to date in various areas (paediatrics, cardiology, oncology, endocrinology, etc.). This article highlights the importance for all physicians to participate, over the course of their professional career, in a clinical trial, due to the inherent benefits for patients, the progress of medicine and for curricular prestige. The authors have created a synthesis of their experience with clinical trials on hypertension, diabetes, dyslipidaemia and ischaemic heart disease over the course of almost 3 decades. Furthermore, a brief reference has been made to the characteristics of a phase I unit, as well as to a number of research studies currently underway.
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Affiliation(s)
- B Gil-Extremera
- Departamento de Medicina, Universidad de Granada, Granada, España.
| | - P Jiménez-López
- Departamento de Medicina, Universidad de Granada, Granada, España
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153
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Csiszar A, Tarantini S, Fülöp GA, Kiss T, Valcarcel-Ares MN, Galvan V, Ungvari Z, Yabluchanskiy A. Hypertension impairs neurovascular coupling and promotes microvascular injury: role in exacerbation of Alzheimer's disease. GeroScience 2017; 39:359-372. [PMID: 28853030 PMCID: PMC5636770 DOI: 10.1007/s11357-017-9991-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/26/2017] [Indexed: 12/13/2022] Open
Abstract
Hypertension in the elderly substantially increases both the risk of vascular cognitive impairment (VCI) and Alzheimer's disease (AD); however, the underlying mechanisms are not completely understood. This review discusses the effects of hypertension on structural and functional integrity of cerebral microcirculation, including hypertension-induced alterations in neurovascular coupling responses, cellular and molecular mechanisms involved in microvascular damage (capillary rarefaction, blood-brain barrier disruption), and the genesis of cerebral microhemorrhages and their potential role in exacerbation of cognitive decline associated with AD. Understanding and targeting the hypertension-induced cerebromicrovascular alterations that are involved in the onset and progression of AD and contribute to cognitive impairment are expected to have a major role in preserving brain health in high-risk older individuals.
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Affiliation(s)
- Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gábor A Fülöp
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Noa Valcarcel-Ares
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Veronica Galvan
- Department of Cellular and Integrative Physiology, Barshop Institute for Longevity and Aging Studies University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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154
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Edwards JD, Ramirez J, Callahan BL, Tobe SW, Oh P, Berezuk C, Lanctôt K, Swardfager W, Nestor S, Kiss A, Strother S, Black SE. Antihypertensive Treatment is associated with MRI-Derived Markers of Neurodegeneration and Impaired Cognition: A Propensity-Weighted Cohort Study. J Alzheimers Dis 2017; 59:1113-1122. [DOI: 10.3233/jad-170238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jodi D. Edwards
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Brandy L. Callahan
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
| | | | - Paul Oh
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Courtney Berezuk
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Krista Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Geriatric Psychiatry, University of Toronto, Toronto, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Sean Nestor
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alexander Kiss
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephen Strother
- Medical Biophysics, University of Toronto, Toronto, Canada
- Rotman Research Institute, Toronto, Canada
| | - Sandra E. Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Toronto, Canada
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155
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156
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The Prevalence of Alzheimer’s Disease; its Risk and Protective Factors Among the Elderly Population in Iran. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/semj.57576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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157
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Aronow WS. Hypertension and cognitive impairment. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:259. [PMID: 28706927 DOI: 10.21037/atm.2017.03.99] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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158
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Hypertension-induced synapse loss and impairment in synaptic plasticity in the mouse hippocampus mimics the aging phenotype: implications for the pathogenesis of vascular cognitive impairment. GeroScience 2017; 39:385-406. [PMID: 28664509 DOI: 10.1007/s11357-017-9981-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/30/2017] [Indexed: 12/22/2022] Open
Abstract
Strong epidemiological and experimental evidence indicates that hypertension has detrimental effects on the cerebral microcirculation and thereby promotes accelerated brain aging. Hypertension is an independent risk factor for both vascular cognitive impairment (VCI) and Alzheimer's disease (AD). However, the pathophysiological link between hypertension-induced cerebromicrovascular injury (e.g., blood-brain barrier disruption, increased microvascular oxidative stress, and inflammation) and cognitive decline remains elusive. The present study was designed to characterize neuronal functional and morphological alterations induced by chronic hypertension and compare them to those induced by aging. To achieve that goal, we induced hypertension in young C57BL/6 mice by chronic (4 weeks) infusion of angiotensin II. We found that long-term potentiation (LTP) of performant path synapses following high-frequency stimulation of afferent fibers was decreased in hippocampal slices obtained from hypertensive mice, mimicking the aging phenotype. Hypertension and advanced age were associated with comparable decline in synaptic density in the stratum radiatum of the mouse hippocampus. Hypertension, similar to aging, was associated with changes in mRNA expression of several genes involved in regulation of neuronal function, including down-regulation of Bdnf, Homer1, and Dlg4, which may have a role in impaired synaptic plasticity. Collectively, hypertension impairs synaptic plasticity, reduces synaptic density, and promotes dysregulation of genes involved in synaptic function in the mouse hippocampus mimicking the aging phenotype. These hypertension-induced neuronal alterations may impair establishment of memories in the hippocampus and contribute to the pathogenesis and clinical manifestation of both vascular cognitive impairment (VCI) and Alzheimer's disease (AD).
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159
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Hernandorena I, Duron E, Vidal JS, Hanon O. Treatment options and considerations for hypertensive patients to prevent dementia. Expert Opin Pharmacother 2017; 18:989-1000. [PMID: 28532183 DOI: 10.1080/14656566.2017.1333599] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Dementia is a worldwide health concern, which leads to loss of autonomy. To date no curative treatment is available so focus on modifiable risk factors is of particular interest. Hypertension, particularly midlife high blood pressure, has been associated with an increased risk for cognitive decline and dementia including vascular dementia (VAD) and Alzheimer disease (AD). In this context, antihypertensive treatments might have a preventive effect. The objective of this review was to examine the relationship between antihypertensive therapy and cognitive decline or dementia. Areas covered: A literature search was conducted using PUBMED and the COCHRANE LIBRARY for publications from 1990 onwards mentioning cognitive decline, AD, Vad, mixed dementia, vascular cognitive impairment, hypertension and antihypertensive therapy. Thirty-nine relevant publications including 20 longitudinal studies, 10 randomized-controlled trials and 9 meta-analyses were taken into account. Expert opinion: Most observational studies have suggested a potential preventive effect of antihypertensive therapies on cognitive decline and dementia, particularly calcium channel blockers and renin-angiotensin system blockers. Randomized clinical trials and meta-analyses provided more conflicting results potentially due to methodological issues. In conclusion, antihypertensive therapies may reduce cognitive decline and incidence of dementia. Further randomized clinical trials conducted in populations at higher risk of cognitive decline, with longer periods of follow-up and cognition as the primary outcome are still needed.
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Affiliation(s)
- Intza Hernandorena
- a Department of Geriatrics , APHP, Hôpital Broca , Paris , France.,b Sorbonne Paris Cité , University Descartes , Paris , France
| | - Emmanuelle Duron
- a Department of Geriatrics , APHP, Hôpital Broca , Paris , France.,b Sorbonne Paris Cité , University Descartes , Paris , France
| | - Jean-Sébastien Vidal
- a Department of Geriatrics , APHP, Hôpital Broca , Paris , France.,b Sorbonne Paris Cité , University Descartes , Paris , France
| | - Olivier Hanon
- a Department of Geriatrics , APHP, Hôpital Broca , Paris , France.,b Sorbonne Paris Cité , University Descartes , Paris , France
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160
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Momin M, Li JP, Zhang Y, Fan FF, Xu XP, Xu X, Wang BY, Yang WB, Xie LL, Huo Y. Body mass index is inversely associated with arterial stiffness in Chinese adults with primary hypertension: results from the China Stroke Primary Prevention Trial (CSPPT). Clin Exp Hypertens 2017; 39:394-401. [PMID: 28534657 DOI: 10.1080/10641963.2016.1254226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study aimed to elucidate the relationship between body mass index (BMI) and the presence of arterial stiffness in rural-dwelling Chinese adults with primary hypertension. METHODS Primary hypertension patients (n = 19,375) receiving an average of 4.5 years of antihypertension therapy were selected from the Chinese Stroke Primary Prevention Trial (mean age: 64.7 ± 7.4 years, male: 37.8%). Anthropometric, demographic, hemodynamic, and biochemical data were obtained. Arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV). RESULTS BMI was inversely associated with baPWV after adjusting for gender, age, smoking, alcohol consumption, center, pulse, SBP, DBP, FBG, TC, TG, HDL-C, BUN, Scr, UA, HCY, antidiabetes treatment, lipid-lowing treatment, and antihypertensive treatment (β (SE): -10.72 (0.69), P < 0.0001). Quintile1 (Q1) was used as a reference; Q2, Q3, Q4, and Q5 groups were all inversely associated with baPWV. The β increased with increasing BMI, β (SE) was -20.29 (6.74), -30.66 (7.01), -51.82 (7.27), and -103.1 (7.62), respectively, for Q2 - Q5, P < 0.05. BMI remained inversely correlated with baPWV across differences in gender, center, blood pressure, lipid levels, and the presence or absence of diabetes subgroups. CONCLUSION Increased BMI is a positive factor against the development of arterial stiffness in Chinese rural-dwelling adults with primary hypertension undergoing antihypertension treatments, after adjusting for confounding factors.
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Affiliation(s)
- Mohetaboer Momin
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Jian-Ping Li
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Yan Zhang
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Fang-Fang Fan
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
| | - Xi-Ping Xu
- b National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Xin Xu
- b National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Bin-Yan Wang
- b National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Wen-Bin Yang
- c Institute for Biomedicine , Anhui Medical University , Hefei , China
| | - Li-Ling Xie
- c Institute for Biomedicine , Anhui Medical University , Hefei , China
| | - Yong Huo
- a Department of Cardiovascular Diseases , Peking University First Hospital , Beijing , China
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161
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Kern KC, Wright CB, Bergfield KL, Fitzhugh MC, Chen K, Moeller JR, Nabizadeh N, Elkind MSV, Sacco RL, Stern Y, DeCarli CS, Alexander GE. Blood Pressure Control in Aging Predicts Cerebral Atrophy Related to Small-Vessel White Matter Lesions. Front Aging Neurosci 2017; 9:132. [PMID: 28555103 PMCID: PMC5430031 DOI: 10.3389/fnagi.2017.00132] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Cerebral small-vessel damage manifests as white matter hyperintensities and cerebral atrophy on brain MRI and is associated with aging, cognitive decline and dementia. We sought to examine the interrelationship of these imaging biomarkers and the influence of hypertension in older individuals. We used a multivariate spatial covariance neuroimaging technique to localize the effects of white matter lesion load on regional gray matter volume and assessed the role of blood pressure control, age and education on this relationship. Using a case-control design matching for age, gender, and educational attainment we selected 64 participants with normal blood pressure, controlled hypertension or uncontrolled hypertension from the Northern Manhattan Study cohort. We applied gray matter voxel-based morphometry with the scaled subprofile model to (1) identify regional covariance patterns of gray matter volume differences associated with white matter lesion load, (2) compare this relationship across blood pressure groups, and (3) relate it to cognitive performance. In this group of participants aged 60–86 years, we identified a pattern of reduced gray matter volume associated with white matter lesion load in bilateral temporal-parietal regions with relative preservation of volume in the basal forebrain, thalami and cingulate cortex. This pattern was expressed most in the uncontrolled hypertension group and least in the normotensives, but was also more evident in older and more educated individuals. Expression of this pattern was associated with worse performance in executive function and memory. In summary, white matter lesions from small-vessel disease are associated with a regional pattern of gray matter atrophy that is mitigated by blood pressure control, exacerbated by aging, and associated with cognitive performance.
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Affiliation(s)
- Kyle C Kern
- Department of Neurology, Evelyn F. McKnight Brain Institute, University of Miami Miller School of MedicineMiami, FL, USA
| | - Clinton B Wright
- Department of Neurology, Evelyn F. McKnight Brain Institute, University of Miami Miller School of MedicineMiami, FL, USA
| | - Kaitlin L Bergfield
- Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, University of ArizonaTucson, AZ, USA.,Department of Psychology and Evelyn F. McKnight Brain Institute, University of ArizonaTucson, AZ, USA
| | - Megan C Fitzhugh
- Department of Psychology and Evelyn F. McKnight Brain Institute, University of ArizonaTucson, AZ, USA
| | - Kewei Chen
- Computational Image Analysis Program, Banner Alzheimer InstitutePhoenix, AZ, USA.,School of Mathematics and Statistics, Arizona State UniversityTempe, AZ, USA.,Arizona Alzheimers ConsortiumPhoenix, AZ, USA
| | - James R Moeller
- Department of Psychiatry, College of Physicians and Surgeons, Columbia UniversityNew York, NY, USA
| | - Nooshin Nabizadeh
- Department of Neurology, Evelyn F. McKnight Brain Institute, University of Miami Miller School of MedicineMiami, FL, USA
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia UniversityNew York, NY, USA
| | - Ralph L Sacco
- Department of Neurology, Evelyn F. McKnight Brain Institute, University of Miami Miller School of MedicineMiami, FL, USA
| | - Yaakov Stern
- Department of Psychiatry, College of Physicians and Surgeons, Columbia UniversityNew York, NY, USA.,Department of Neurology, College of Physicians and Surgeons, Columbia UniversityNew York, NY, USA
| | - Charles S DeCarli
- Department of Neurology and Center for Neuroscience, University of California, DavisDavis, CA, USA
| | - Gene E Alexander
- Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, University of ArizonaTucson, AZ, USA.,Department of Psychology and Evelyn F. McKnight Brain Institute, University of ArizonaTucson, AZ, USA.,Arizona Alzheimers ConsortiumPhoenix, AZ, USA.,Department of Psychiatry and BIO5 Institute, University of ArizonaTucson, AZ, USA
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162
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Abstract
Cerebrovascular disease (CVD) is the second leading cause of cognitive impairment in late life. Structural neuroimaging offers the most sensitive and specific biomarkers for hemorrhages and infarcts, but there are significant limitations in its ability to detect microvascular disease, microinfarcts, dynamic changes in the blood-brain barrier, and preclinical cerebrovascular disease. Autopsy studies disclose the common co-occurrence of vascular and neurodegenerative conditions, suggesting that in late life, a multifactorial approach to cognitive impairment may be more appropriate than traditional dichotomous classifications. Management of vascular risk factors remains a proven and practical approach to reducing acute and progressive cognitive impairment and dementia.
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Affiliation(s)
- Helena C Chui
- Department of Neurology, University of Southern California, 1540 Alcazar Street, CHP215, Los Angeles, CA 90033, USA.
| | - Liliana Ramirez Gomez
- Department of Neurology, University of California San Francisco, 400 Parnassus Avenue, A871, San Francisco, CA 94143, USA
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163
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Isolated Systolic Hypertension in Young Individuals: Pathophysiological Mechanisms, Prognostic Significance, and Clinical Implications. High Blood Press Cardiovasc Prev 2017; 24:133-139. [PMID: 28374153 DOI: 10.1007/s40292-017-0199-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/27/2017] [Indexed: 01/13/2023] Open
Abstract
Isolated systolic hypertension (ISH) is the most common form of hypertension in older persons and its predictive value for adverse outcome is well known. However, ISH can be frequently found also in young individuals, especially among males, but its prognostic significance in this setting is still controversial. Increased large artery stiffness is the main determinant of ISH in elderly patients whereas the mechanisms that lead to ISH in the young are still debated. According to some authors ISH in youth is a totally benign condition that can be called "spurious hypertension" a phenomenon due to enhanced pulse pressure amplification of the pulse wave from central to peripheral sites. According to others the main determinant of ISH in young individuals is increased sympathetic activity and the consequent hyperkinetic state characterized by elevated heart rate and stroke volume. This phenomenon is often amplified by a powerful alarm reaction to the medical visit. However, recent research has shown that ISH in the young is a heterogeneous condition and that in some individuals also increased arterial stiffness can play a role. Although ISH seems to be a benign condition chiefly in young men, only few longitudinal data assessing the association with adverse outcomes are available. Future studies with long term follow-up are needed to better understand the clinical significance of this condition.
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164
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The Aging Cardiovascular System. J Am Coll Cardiol 2017; 69:1952-1967. [DOI: 10.1016/j.jacc.2017.01.064] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 12/31/2022]
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165
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Abstract
Incident stroke has long been recognized to cause dementia shortly after the event. Patients who survive stroke without early-onset poststroke dementia (PSD) are at a high risk of developing dementia months to years after the initial stroke incident, which has generated enthusiasm for exploring treatments to prevent delayed-onset PSD in survivors of stroke. However, results from clinical trials completed in the past 10-15 years have been disappointing. In light of these results, the present Review revisits the mechanisms of both early-onset and delayed-onset PSD and proposes preventive strategies and directions for future clinical trials. Early-onset PSD results from a complex interplay between stroke lesion features and brain resilience, whereas delayed-onset PSD is associated mainly with the presence of severe sporadic small vessel disease (SVD), and to a lesser extent with Alzheimer disease pathology or recurrent stroke. As well as preventing stroke and delivering acute stroke treatments to reduce initial brain damage, measures to increase brain resilience could also reduce the risk of developing dementia if an incident stroke occurs. Future efforts to prevent delayed-onset PSD should focus on the study of sporadic SVD and on evaluating whether other strategies, in addition to conventional secondary stroke prevention, are effective in dementia prevention in this high-risk group.
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166
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Vakhnina NN, Zakharov VV. Disturbances of gait and postural stability in chronic cerebral ischemia. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro20171171178-84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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167
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Toth P, Tarantini S, Csiszar A, Ungvari Z. Functional vascular contributions to cognitive impairment and dementia: mechanisms and consequences of cerebral autoregulatory dysfunction, endothelial impairment, and neurovascular uncoupling in aging. Am J Physiol Heart Circ Physiol 2017; 312:H1-H20. [PMID: 27793855 PMCID: PMC5283909 DOI: 10.1152/ajpheart.00581.2016] [Citation(s) in RCA: 319] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 12/16/2022]
Abstract
Increasing evidence from epidemiological, clinical and experimental studies indicate that age-related cerebromicrovascular dysfunction and microcirculatory damage play critical roles in the pathogenesis of many types of dementia in the elderly, including Alzheimer's disease. Understanding and targeting the age-related pathophysiological mechanisms that underlie vascular contributions to cognitive impairment and dementia (VCID) are expected to have a major role in preserving brain health in older individuals. Maintenance of cerebral perfusion, protecting the microcirculation from high pressure-induced damage and moment-to-moment adjustment of regional oxygen and nutrient supply to changes in demand are prerequisites for the prevention of cerebral ischemia and neuronal dysfunction. This overview discusses age-related alterations in three main regulatory paradigms involved in the regulation of cerebral blood flow (CBF): cerebral autoregulation/myogenic constriction, endothelium-dependent vasomotor function, and neurovascular coupling responses responsible for functional hyperemia. The pathophysiological consequences of cerebral microvascular dysregulation in aging are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages, microvascular rarefaction, and ischemic neuronal dysfunction and damage. Due to the widespread attention that VCID has captured in recent years, the evidence for the causal role of cerebral microvascular dysregulation in cognitive decline is critically examined.
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Affiliation(s)
- Peter Toth
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Neurosurgery and Szentagothai Research Center, University of Pecs, Pecs, Hungary; and
| | - Stefano Tarantini
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Anna Csiszar
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
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168
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Hsu DC, Marshall GA. Primary and Secondary Prevention Trials in Alzheimer Disease: Looking Back, Moving Forward. Curr Alzheimer Res 2017; 14:426-440. [PMID: 27697063 PMCID: PMC5329133 DOI: 10.2174/1567205013666160930112125] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/10/2016] [Accepted: 09/22/2016] [Indexed: 12/20/2022]
Abstract
The field of Alzheimer disease (AD) prevention has been a culmination of basic science, clinical, and translational research. In the past three years since the new 2011 AD diagnostic guidelines, large-scale collaborative efforts have embarked on new clinical trials with the hope of someday preventing AD. This review will shed light on the historical and scientific contexts in which these trials were based on, as well as discuss potential challenges these trials may face in the coming years. Primary preventive measures, such as lifestyle, multidomain, medication, and supplemental interventions, will be analyzed. Secondary prevention as represented by disease-modifying interventions, such as antiamyloid therapy and pioglitazone, will also be reviewed. Finally, hypotheses on future directions for AD prevention trials will be proposed.
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Affiliation(s)
- David C. Hsu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Gad A. Marshall
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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169
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Nishihira J, Tokashiki T, Higashiuesato Y, Willcox DC, Mattek N, Shinto L, Ohya Y, Dodge HH. Associations between Serum Omega-3 Fatty Acid Levels and Cognitive Functions among Community-Dwelling Octogenarians in Okinawa, Japan: The KOCOA Study. J Alzheimers Dis 2016; 51:857-66. [PMID: 26890763 DOI: 10.3233/jad-150910] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Epidemiological studies have found frequent consumption of fatty fish is protective against cognitive decline. However, the association between circulating omega-3 polyunsaturated fatty acid (PUFA) levels and cognitive functions among the oldest old is not well known. OBJECTIVE To examine the association between serum PUFA levels and cognitive function among community-dwelling, non-demented elderly aged over 80 years old. METHODS The data came from the Keys to Optimal Cognitive Aging (KOCOA) study; an ongoing cohort of relatively healthy volunteers aged over 80 years old, living in Okinawa, Japan. One hundred eighty five participants (mean age 84.1±3.4 years) assessed in 2011 who were free from frank dementia (defined as Clinical Dementia Rating <1.0) were used for the current cross-sectional study. We examined whether serum omega-3 PUFAs (docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]), arachidonic acid (AA), EPA/AA ratio, DHA/AA ratio, and DHA+EPA are associated with (1) age and (2) global cognitive function (Japanese MMSE) and executive function (Verbal Fluency Letter). Data was analyzed univariately by t-test and multivariately by cumulative logistic regression models controlling for age, gender, years of education, obesity, hypertension, diabetes, and dyslipidemia. RESULTS Serum DHA levels decreased with increasing age (p = 0.04). Higher global cognitive function was associated with higher levels of serum EPA (p = 0.03) and DHA + EPA (p = 0.03) after controlling for confounders. CONCLUSIONS Higher serum EPA and DHA + EPA levels were independently associated with better scores on global cognitive function among the oldest old, free from dementia. Longitudinal follow-up studies are warranted.
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Affiliation(s)
- Junko Nishihira
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Takashi Tokashiki
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | | | - Donald Craig Willcox
- Department of Human Welfare, Okinawa International University, Okinawa, Japan.,Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Nora Mattek
- Department of Neurology and Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Lynne Shinto
- Department of Neurology and Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Hiroko H Dodge
- Department of Neurology and Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,Department of Neurology and Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, USA
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170
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Wang J, Tan L, Yu JT. Prevention Trials in Alzheimer's Disease: Current Status and Future Perspectives. J Alzheimers Dis 2016; 50:927-45. [PMID: 26836177 DOI: 10.3233/jad-150826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia in the elderly. Over the past 20 years, both pharmacological and lifestyle interventions have been studied for AD prevention, but the overall results have been disappointing. The majority of disappointing results have raised questions and great challenges for the future of AD prevention trials. Ongoing advances in the knowledge of pathogenesis, in the identification of novel targets, in improved outcome measures, and in identification and validation of biomarkers may lead to effective strategies for AD prevention. In this paper, we review the selection of participants and interventions, trial design, outcome assessments, and promising biomarkers in prevention trials, and summarize the lessons learned from completed trials and perspectives from ongoing trials in AD prevention. Selection of optimal participants and interventions, coupled with more refined outcomes and more efficient trial design, may have the capacity to deliver a new era of preventive discovery in this challenging area.
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Affiliation(s)
- Jun Wang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China.,Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Yuzhong District, Chongqing, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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171
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Kehoe PG, Wong S, Al Mulhim N, Palmer LE, Miners JS. Angiotensin-converting enzyme 2 is reduced in Alzheimer's disease in association with increasing amyloid-β and tau pathology. ALZHEIMERS RESEARCH & THERAPY 2016; 8:50. [PMID: 27884212 PMCID: PMC5123239 DOI: 10.1186/s13195-016-0217-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/20/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hyperactivity of the classical axis of the renin-angiotensin system (RAS), mediated by angiotensin II (Ang II) activation of the angiotensin II type 1 receptor (AT1R), is implicated in the pathogenesis of Alzheimer's disease (AD). Angiotensin-converting enzyme-2 (ACE-2) degrades Ang II to angiotensin 1-7 (Ang (1-7)) and counter-regulates the classical axis of RAS. We have investigated the expression and distribution of ACE-2 in post-mortem human brain tissue in relation to AD pathology and classical RAS axis activity. METHODS We measured ACE-2 activity by fluorogenic peptide substrate assay in mid-frontal cortex (Brodmann area 9) in a cohort of AD (n = 90) and age-matched non-demented controls (n = 59) for which we have previous data on ACE-1 activity, amyloid β (Aβ) level and tau pathology, as well as known ACE1 (rs1799752) indel polymorphism, apolipoprotein E (APOE) genotype, and cerebral amyloid angiopathy severity scores. RESULTS ACE-2 activity was significantly reduced in AD compared with age-matched controls (P < 0.0001) and correlated inversely with levels of Aβ (r = -0.267, P < 0.001) and phosphorylated tau (p-tau) pathology (r = -0.327, P < 0.01). ACE-2 was reduced in individuals possessing an APOE ε4 allele (P < 0.05) and was associated with ACE1 indel polymorphism (P < 0.05), with lower ACE-2 activity in individuals homozygous for the ACE1 insertion AD risk allele. ACE-2 activity correlated inversely with ACE-1 activity (r = -0.453, P < 0.0001), and the ratio of ACE-1 to ACE-2 was significantly elevated in AD (P < 0.0001). Finally, we show that the ratio of Ang II to Ang (1-7) (a proxy measure of ACE-2 activity indicating conversion of Ang II to Ang (1-7)) is reduced in AD. CONCLUSIONS Together, our findings indicate that ACE-2 activity is reduced in AD and is an important regulator of the central classical ACE-1/Ang II/AT1R axis of RAS, and also that dysregulation of this pathway likely plays a significant role in the pathogenesis of AD.
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Affiliation(s)
- Patrick Gavin Kehoe
- Dementia Research Group, University of Bristol, Level 1, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Steffenny Wong
- Dementia Research Group, University of Bristol, Level 1, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Noura Al Mulhim
- Dementia Research Group, University of Bristol, Level 1, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Laura Elyse Palmer
- Dementia Research Group, University of Bristol, Level 1, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK
| | - J Scott Miners
- Dementia Research Group, University of Bristol, Level 1, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
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Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, Gulati M, Kamel H, Knopman DS, Launer LJ, Saczynski JS, Seshadri S, Zeki Al Hazzouri A. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e67-e94. [PMID: 27977393 DOI: 10.1161/hyp.0000000000000053] [Citation(s) in RCA: 404] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. METHODS Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. CONCLUSIONS After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.
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173
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Osmanovic-Barilar J, Salkovic-Petrisi M. Evaluating the Role of Hormone Therapy in Postmenopausal Women with Alzheimer’s Disease. Drugs Aging 2016; 33:787-808. [DOI: 10.1007/s40266-016-0407-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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174
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Hwang D, Kim S, Choi H, Oh IH, Kim BS, Choi HR, Kim SY, Won CW. Calcium-Channel Blockers and Dementia Risk in Older Adults - National Health Insurance Service - Senior Cohort (2002-2013). Circ J 2016; 80:2336-2342. [PMID: 27666598 DOI: 10.1253/circj.cj-16-0692] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Some disagreements surround the effects of calcium-channel blockers (CCBs) on the risk of dementia. The purpose of this study was to investigate the protective effects of CCBs on dementia among elderly hypertensive Koreans.Methods and Results:We conducted a large population-based cohort study using the senior cohort database of the Korean National Health Insurance Service (2002-2013). Subjects were elderly hypertensive Koreans older than 60 years of age. A total of 18,423 patients (CCB user group: 13,692 patients; non-CCB antihypertensive user group: 4,731 patients) were statistically analyzed using the Cox proportional hazard regression model to estimate the adjusted hazard ratio (aHR) and confidence intervals (CIs) of dementia associated with CCB use. There were 2,881 cases (21.0%) of dementia in the CCB user group and 1,124 cases (23.8%) in the non-user group. CCB use significantly reduced the risk of total dementia (aHR 0.81, 95% CI 0.75-0.87, P<0.0001), Alzheimer's dementia (aHR 0.80, 95% CI 0.72-0.88, P<0.0001), and vascular dementia (aHR 0.81, 95% CI 0.70-0.94, P=0.0067). CONCLUSIONS CCB use had a protective effect on the risk of dementia among elderly hypertensive Koreans. (Circ J 2016; 80: 2336-2342).
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Affiliation(s)
- Deri Hwang
- Department of Family Medicine, College of Medicine, Kyung Hee University
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175
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Moll van Charante EP, Richard E, Eurelings LS, van Dalen JW, Ligthart SA, van Bussel EF, Hoevenaar-Blom MP, Vermeulen M, van Gool WA. Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet 2016; 388:797-805. [PMID: 27474376 DOI: 10.1016/s0140-6736(16)30950-3] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiovascular risk factors are associated with an increased risk of dementia. We assessed whether a multidomain intervention targeting these factors can prevent dementia in a population of community-dwelling older people. METHODS In this open-label, cluster-randomised controlled trial, we recruited individuals aged 70-78 years through participating general practices in the Netherlands. General practices within each health-care centre were randomly assigned (1:1), via a computer-generated randomisation sequence, to either a 6-year nurse-led, multidomain cardiovascular intervention or control (usual care). The primary outcomes were cumulative incidence of dementia and disability score (Academic Medical Center Linear Disability Score [ALDS]) at 6 years of follow-up. The main secondary outcomes were incident cardiovascular disease and mortality. Outcome assessors were masked to group assignment. Analyses included all participants with available outcome data. This trial is registered with ISRCTN, number ISRCTN29711771. FINDINGS Between June 7, 2006, and March 12, 2009, 116 general practices (3526 participants) within 26 health-care centres were recruited and randomly assigned: 63 (1890 participants) were assigned to the intervention group and 53 (1636 participants) to the control group. Primary outcome data were obtained for 3454 (98%) participants; median follow-up was 6·7 years (21 341 person-years). Dementia developed in 121 (7%) of 1853 participants in the intervention group and in 112 (7%) of 1601 participants in the control group (hazard ratio [HR] 0·92, 95% CI 0·71-1·19; p=0·54). Mean ALDS scores measured during follow-up did not differ between groups (85·7 [SD 6·8] in the intervention group and 85·7 [7·1] in the control group; adjusted mean difference -0·02, 95% CI -0·38 to 0·42; p=0·93). 309 (16%) of 1885 participants died in the intervention group, compared with 269 (16%) of 1634 participants in the control group (HR 0·98, 95% CI 0·80-1·18; p=0·81). Incident cardiovascular disease did not differ between groups (273 [19%] of 1469 participants in the intervention group and 228 [17%] of 1307 participants in the control group; HR 1·06, 95% CI 0·86-1·31; p=0·57). INTERPRETATION A nurse-led, multidomain intervention did not result in a reduced incidence of all-cause dementia in an unselected population of older people. This absence of effect might have been caused by modest baseline cardiovascular risks and high standards of usual care. Future studies should assess the efficacy of such interventions in selected populations. FUNDING Dutch Ministry of Health, Welfare and Sport; Dutch Innovation Fund of Collaborative Health Insurances; and Netherlands Organisation for Health Research and Development.
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Affiliation(s)
| | - Edo Richard
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands; Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lisa S Eurelings
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Suzanne A Ligthart
- Department of General Practice, Academic Medical Centre, Amsterdam, Netherlands
| | - Emma F van Bussel
- Department of General Practice, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Marinus Vermeulen
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands.
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176
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Wu CL, Wen SH. A 10-year follow-up study of the association between calcium channel blocker use and the risk of dementia in elderly hypertensive patients. Medicine (Baltimore) 2016; 95:e4593. [PMID: 27512890 PMCID: PMC4985345 DOI: 10.1097/md.0000000000004593] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 01/06/2023] Open
Abstract
Calcium channel blockers (CCBs) are widely used for reducing blood pressure of hypertensive patients. Recent reports document the beneficial effects of CCB for preventing dementia; however, the results are controversial. We aim to evaluate the risk of developing dementia among elderly hypertensive patients treated with CCB.We designed a retrospective population-based cohort study using the records of the National Health Insurance Research Database of Taiwan dated from 2000 to 2010. The study cohort comprised 82,107 hypertensive patients of more than 60 years of age, and 4004 propensity score (PS)-matched pairs were selected according to age, sex, year of hypertension diagnosis, and baseline comorbidities. We employed a robust Cox proportional hazard model to estimate the hazard ratio (HR) of developing dementia in the PS-matched cohort.The annual incidence of dementia in the CCB-exposure group was significantly lower than that in the comparator group (3.9 vs 6.9 per 1000 person-years, P < 0.01) during the follow-up period (4.4 ± 2.5 years). Based on the PS-matched cohort, the adjusted HR of dementia in the CCB-exposure group was significantly lower than that in comparator group (HR = 0.53, 95% confidence interval: 0.39-0.72, P < 0.01). Sensitivity and subgroup analyses also confirmed similar findings.Our results provided evidence for an association between CCB use and a lower risk of developing dementia among the elderly hypertensive patients. Further studies are required to explore the causal relationship between CCB use and dementia.
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Affiliation(s)
- Chia-Liang Wu
- Department of Psychiatry, Taipei Veterans General Hospital, Yuli Branch
| | - Shu-Hui Wen
- Department of Public Health, College of Medicine, Tzu Chi University, Hualien, Taiwan
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Bu X, Zhang Y, Bazzano LA, Xu T, Guo L, Wang X, Zhang J, Cui Y, Li D, Zhang F, Ju Z, Xu T, Chen CS, Chen J, He J. Effects of early blood pressure reduction on cognitive function in patients with acute ischemic stroke. Int J Stroke 2016; 11:1009-1019. [PMID: 27412188 DOI: 10.1177/1747493016660094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/07/2016] [Indexed: 12/21/2022]
Abstract
Background The effect of early blood pressure reduction on cognitive function in patients with acute ischemic stroke remains unknown. Aim We tested whether antihypertensive treatment would reduce cognitive impairment in patients with acute ischemic stroke. Methods In the China Antihypertensive Trial in Acute Ischemic Stroke, patients with elevated blood pressure were randomly assigned to receive antihypertensive treatment or to discontinue all hypertensive medications within 48 h of onset. Cognitive function was measured by the Mini-Mental State Examination and Montreal Cognitive Assessment at 3 months after randomization in a subsample of 638 participants. Results Mean systolic blood pressure was reduced by 21.5 mmHg in the antihypertensive treatment group and 13.9 mmHg in the control group within 24 h after randomization ( P < 0.001). Mean systolic blood pressure was 134.9 mmHg in the antihypertensive treatment group and 141.6 mmHg in the control group at day 14 after randomization ( P < 0.001). Median Mini-Mental State Examination score was 26 and Montreal Cognitive Assessment score was 22 in both the antihypertensive treatment and control groups at 3 months. An Mini-Mental State Examination < 24 was present in 30.9% of patients in the antihypertensive treatment group compared with 29.7% in the control group (odds ratio = 1.06; 95% confidence interval 0.75–1.48; P = 0.75). Likewise, proportions of patients with Montreal Cognitive Assessment < 26 were similar between the antihypertensive treatment (70.6%) and control (70.7%) groups (odds ratio = 0.99; 95% confidence interval 0.70–1.40; P = 0.96). Conclusions These data indicated that early blood pressure reduction with antihypertensive medication in patients with acute ischemic stroke had no effect on cognitive impairment at 3 months.
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Affiliation(s)
- Xiaoqing Bu
- School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Yonghong Zhang
- School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Tan Xu
- School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Libing Guo
- Department of Neurology, Siping Central Hospital, Jilin, China
| | - Xuemei Wang
- Department of Neurology, Jilin Central Hospital, Jilin, China
| | - Jintao Zhang
- Department of Neurology, The 88th Hospital of PLA, Shandong, China
| | - Yong Cui
- Department of Neurology, General Hospital of First Automobile Works, Jilin, China
| | - Dong Li
- Department of Neurology, Feicheng City People’s Hospital, Shandong, China
| | - Fengshan Zhang
- Department of Neurology, Tongliao Municipal Hospital, Inner Mongolia, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People’s Hospital of Tongliao City, Inner Mongolia, China
| | - Tian Xu
- School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, USA
| | - Jiang He
- School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, USA
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Feldman L, Vinker S, Efrati S, Beberashvili I, Gorelik O, Wasser W, Shani M. Amlodipine treatment of hypertension associates with a decreased dementia risk. Clin Exp Hypertens 2016; 38:545-9. [PMID: 27392121 DOI: 10.3109/10641963.2016.1174249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertension has been shown to be a risk factor for development of dementia. However, medical treatment of hypertension failed to reduce consistently the risk of dementia. Experimental study pointed to the possibility of difference between different calcium channel blockers (CCB) in their neuro-protective effect. The aim of our study was to evaluate the risk of dementia during treatment of hypertension with different CCBs. This is a retrospective cohort study based on electronic database of a large public health care organization. Study period was 11 years and it included patients aged 40-75 years old, having diagnosis of hypertension without diagnosis of dementia at the starting point, treated with either single specific CCB (study group) or with other than CCBs antihypertensive medications (control group) for at least 30 months during the study period. A total of 15,664 patients that satisfied these criteria were identified: 3,884 were treated with amlodipine, 2,062 were treated with nifedipine, 609 were treated with lercanidipine, and 9,109 never received CCBs. Dementia developed in 765 (4.9%) patients. Adjusted hazard ratio (HR) for dementia in patients treated with amlodipine, nifedipine, and lercanidipine was 0.60 (p < 0.001), 0.89 (NS), and 0.90 (NS). Decreased adjusted HR of dementia with amlodipine was demonstrated in the patients aged 60 or more (HR 0.61 [0.49-0.77], p < 0.001), but not in the patients aged less than 60 years old. This study shows that amlodipine therapy may be associated with a decreased dementia risk in hypertensive individuals older than 60 years, compared to those treated without CCBs.
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Affiliation(s)
- Leonid Feldman
- a Nephrology Department and Internal Medicine Department , Assaf Harofeh Medical Center , Zerifin , Israel.,d Sackler School of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Shlomo Vinker
- b Clalit Health Services , Family Medicine Department , Central District , Rishon LeZion , Israel.,d Sackler School of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Shai Efrati
- a Nephrology Department and Internal Medicine Department , Assaf Harofeh Medical Center , Zerifin , Israel.,d Sackler School of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Ilia Beberashvili
- a Nephrology Department and Internal Medicine Department , Assaf Harofeh Medical Center , Zerifin , Israel.,d Sackler School of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Oleg Gorelik
- a Nephrology Department and Internal Medicine Department , Assaf Harofeh Medical Center , Zerifin , Israel.,d Sackler School of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Walter Wasser
- c Nephrology Clinic , Mayanei HaYeshua Medical Center and Rambam Health Care Campus , Haifa , Israel
| | - Michal Shani
- b Clalit Health Services , Family Medicine Department , Central District , Rishon LeZion , Israel.,d Sackler School of Medicine , Tel-Aviv University , Tel Aviv , Israel
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Osone A, Arai R, Hakamada R, Shimoda K. Impact of lifestyle-related disease on conversion and reversion in patients with mild cognitive impairment: after 12 months of follow-up. Int J Geriatr Psychiatry 2016; 31:740-8. [PMID: 26593034 DOI: 10.1002/gps.4386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/09/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the study is to investigate whether the lifestyle-related disease (LSRD) hypertension, type II diabetes mellitus, and lipid abnormality are associated with conversion and reversion in patients with mild cognitive impairment (MCI) over 12 months of follow-up. METHODS One hundred and thirteen patients with MCI were prospectively enrolled and longitudinally assessed. Methods used include mini-mental state examination, the Japanese version of the cognitive subscale of the Alzheimer's Disease Assessment Scale, the Clinical Dementia Rating, the Frontal Assessment Battery, the Neuropsychiatric Inventory, magnetic resonance imaging, and quantitative single-photon emission computed tomography. In addition, laboratory examinations of glucose and lipids were also performed. All measurements were performed at first intake and again at the end of the 12-month follow-up. Conversion was identified as a change in Clinical Dementia Rating from 0.5 to 1 and reversion as a change from 0.5 to 0. RESULTS Patients with MCI with reversion had lower comorbid lipid abnormality at baseline and higher cognitive and behaviour function across the 12-month follow-up compared with those with no change or conversion. Patients without comorbid LSRD had lower systolic pressure and lower glucose and triglyceride levels at baseline, as well as less cognitive decline compared with other groups across the follow-up period. CONCLUSIONS The absence of lipid abnormality at baseline may contribute to reversion in patients with MCI. The presence of multiple LSRD was associated with cognitive decline. Our results highlight the contribution of multiple LSRD on increasing conversion and decreasing reversion in patients with MCI. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Akira Osone
- Department of Psychiatry and Center for Dementia-Related Diseases, Dokkyo Medical University School of Medicine, Mibu, Shimotsuga, Tochigi, Japan
| | - Reiko Arai
- Department of Psychiatry and Center for Dementia-Related Diseases, Dokkyo Medical University School of Medicine, Mibu, Shimotsuga, Tochigi, Japan
| | - Rina Hakamada
- Department of Psychiatry and Center for Dementia-Related Diseases, Dokkyo Medical University School of Medicine, Mibu, Shimotsuga, Tochigi, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry and Center for Dementia-Related Diseases, Dokkyo Medical University School of Medicine, Mibu, Shimotsuga, Tochigi, Japan
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Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers reduced dementia risk in patients with diabetes mellitus and hypertension. Int J Cardiol 2016; 220:462-6. [PMID: 27390970 DOI: 10.1016/j.ijcard.2016.06.215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/25/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) on dementia risk in patients with type 2 diabetes mellitus (DM) and hypertension remain unknown. We investigated the effects of ACEIs and ARBs on dementia risk in patients with type 2 DM and hypertension. METHODS We conducted a cohort study by using the Taiwan National Health Insurance Research Database. We included 2377 patients receiving ACEIs and 1780 patients receiving ARBs in the ACEI and ARB cohorts, respectively. We included a comparable number of patients not receiving ACEIs and ARBs as controls in the non-ACEI and non-ARB cohorts through propensity score matching. The effect of ACEIs and ARBs on dementia risk was estimated through multivariate Cox proportional hazard regression after adjustment for several confounding factors. RESULTS During the 12-year follow-up period, compared with the non-ACEI cohort, all-cause dementia risk decreased by 26% in the ACEI cohort [hazard ratio (HR)=0.74, 95% confidence interval (CI)=0.56-0.96]. The all-cause dementia risk was nearly 40% lower in the ARB cohort than in the non-ARB cohort (HR=0.60, 95% CI=0.37-0.97). These drugs prevented the occurrence of vascular dementia (VD), however, this effect was nonsignificant for Alzheimer's dementia (AD). Treatment duration- and dosage-related protection effects on dementia occurrence were observed. CONCLUSIONS ACEIs and ARBs may effectively prevent all-cause dementia, particularly VD, in patients with type 2 DM and hypertension. Moreover, compared with ACEIs, ARBs appear to be more advantageous in dementia prevention.
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Frances A, Sandra O, Lucy U. Vascular cognitive impairment, a cardiovascular complication. World J Psychiatry 2016; 6:199-207. [PMID: 27354961 PMCID: PMC4919258 DOI: 10.5498/wjp.v6.i2.199] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 02/05/2023] Open
Abstract
Over the past two decades, the term vascular cognitive impairment (VCI) has been used to refer to a spectrum of cognitive decline characterized by executive dysfunction, associated with vascular pathology. With 30% of stroke survivors showing cognitive impairments, it is regarded as the most common cause of cognitive impairment. This is a narrative review of available literature citing sources from PubMed, MEDLINE and Google Scholar. VCI has a high prevalence both before and after a stroke and is associated with great economic and caregiver burden. Despite this, there is no standardized diagnostic criteria for VCI. Hypertension has been identified as a risk factor for VCI and causes changes in cerebral vessel structure and function predisposing to lacuna infarcts and small vessel haemorrhages in the frontostriatal loop leading to executive dysfunction and other cognitive impairments. Current trials have shown promising results in the use of antihypertensive medications in the management of VCI and prevention of disease progression to vascular dementia. Prevention of VCI is necessary in light of the looming dementia pandemic. All patients with cardiovascular risk factors would therefore benefit from cognitive screening with screening instruments sensitive to executive dysfunction as well as prompt and adequate control of hypertension.
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Antihypertensive drug use and risk of cognitive decline in the very old: an observational study - the Newcastle 85+ Study. J Hypertens 2016; 33:2156-64. [PMID: 26237554 DOI: 10.1097/hjh.0000000000000653] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Older adults are a fast growing group in society and are at high risk of hypertension, cognitive decline and dementia. Antihypertensive drugs, particularly calcium channel blockers (CCB), have been associated with a decreased risk of cognitive decline and dementia. We used observational data to examine the association between antihypertensive drug class and change in cognitive function. METHODS The Newcastle 85+ Study is a population-based cohort study recruiting individuals aged 85 (born in 1921) via general/family practices in Newcastle/North Tyneside, United Kingdom. Data, including blood pressure, antihypertensive drug use and cognitive function [assessed using the Standardized Mini-Mental State Exam (SMMSE)], were collected at baseline and 3-year follow-up. RESULTS The study population comprised 238 participants with a diagnosis of hypertension, prescribed antihypertensive drug treatment and with baseline and follow-up SMMSE assessment. There was an association between CCB use and less cognitive decline over 3 years (rate of decline was lower by 1.29 SMMSE points (95% confidence interval 0.16-2.42; P = 0.03) compared with those taking other antihypertensive classes after adjustment for age, sex, years of education, baseline SMMSE score, smoking, BMI, baseline blood pressure, and incident cerebrovascular event. This finding was even stronger in the cognitively intact (SMMSE >24), wherein rate of cognitive decline was lower by 1.33 SMMSE points (95% confidence interval 0.30-2.37; P = 0.01), but was not seen for other antihypertensive classes. CONCLUSION Findings provide support for an association between CCB use and a lower rate of cognitive decline in very old adults with hypertension.
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Qin B, Viera AJ, Muntner P, Plassman BL, Edwards LJ, Adair LS, Popkin BM, Mendez MA. Visit-to-Visit Variability in Blood Pressure Is Related to Late-Life Cognitive Decline. Hypertension 2016; 68:106-13. [PMID: 27217401 DOI: 10.1161/hypertensionaha.116.07494] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/01/2016] [Indexed: 01/06/2023]
Abstract
The association between visit-to-visit variability of blood pressure (BP) and cognitive decline over time remains incompletely understood in a general population of older adults. We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. This prospective cohort study comprised 976 adults who had 3 or 4 visits with BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed cognitive screening tests at ≥2 visits in 1997, 2000, or 2004. Visit-to-visit BP variability was expressed as the SD, coefficient of variation, or as the variation independent of mean BP across visits conducted at a mean interval of 3.2 years. Mean (SD) age at the first cognitive test was 64 (6) years. Using multivariable-adjusted linear mixed-effects models, we found higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% confidence interval] for high versus low tertile of SD variability: standardized composite scores -0.038 standard units (SU)/y [-0.066 to -0.009] and verbal memory -0.041 SU/y [-0.075 to -0.008]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of cognitive function, independent of mean diastolic BP, among adults aged 55 to 64 years but not those ≥65 years. Our results suggest that higher long-term BP visit-to-visit variability is associated with a faster rate of cognitive decline among older adults.
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Affiliation(s)
- Bo Qin
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.)
| | - Anthony J Viera
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.)
| | - Paul Muntner
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.)
| | - Brenda L Plassman
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.)
| | - Lloyd J Edwards
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.)
| | - Linda S Adair
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.)
| | - Barry M Popkin
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.)
| | - Michelle A Mendez
- From the Department of Nutrition (B.Q., L.S.A., B.M.P., M.A.M.), Hypertension Research Program, Department of Family Medicine (A.J.V.), and Department of Biostatistics (L.J.E.), University of North Carolina at Chapel Hill; Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick (B.Q.); Department of Epidemiology, University of Alabama at Birmingham (P.M.); and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (B.L.P.).
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Hempel P, Heinig B, Jerosch C, Decius I, Karczewski P, Kassner U, Kunze R, Steinhagen-Thiessen E, Bimmler M. Immunoadsorption of Agonistic Autoantibodies Against α1-Adrenergic Receptors in Patients With Mild to Moderate Dementia. Ther Apher Dial 2016; 20:523-529. [PMID: 27096216 DOI: 10.1111/1744-9987.12415] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/21/2022]
Abstract
Dementia has been shown to be associated with agonistic autoantibodies. The deleterious action of autoantibodies on the α1-adrenergic receptor for brain vasculature has been demonstrated in animal studies. In the current study, 169 patients with dementia were screened for the presence of agonistic autoantibodies. 47% of patients suffering from mild to moderate Alzheimer's disease and/or vascular dementia carried these autoantibodies. Eight patients positive for autoantibodies underwent immunoadsorption. Patients treated on four consecutive days were subsequently negative for autoantibodies and displayed stabilization of cognitive and mental condition during 12-18 months' follow-up. In patients treated for 2-3 days, autoantibodies were reduced by only 78%. They suffered a rebound of autoantibodies during follow-up, benefited from immunoadsorption too, but their mental parameters worsened. We provide first data on the clinical relevance of agonistic autoantibodies in dementia and show that immunoadsorption is safe and efficient in removing autoantibodies with overall benefits for patients.
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Affiliation(s)
| | - Bente Heinig
- Charité - University Medicine Berlin, Berlin, Germany
| | | | - Imke Decius
- Charité - University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Marion Bimmler
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
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Coca A, Monteagudo E, Doménech M, Camafort M, Sierra C. Can the Treatment of Hypertension in the Middle-Aged Prevent Dementia in the Elderly? High Blood Press Cardiovasc Prev 2016; 23:97-104. [PMID: 27075454 DOI: 10.1007/s40292-016-0144-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022] Open
Abstract
Hypertension, one of the main risk factors for cardiovascular disease, is thought to play a crucial role in the pathophysiology of cognitive impairment. Studies have associated hypertension with subjective cognitive failures and objective cognitive decline. Subjective cognitive failures may reflect the early phase of a long pathological process leading to cognitive decline and dementia that has been associated with hypertension and other cardiovascular risk factors. The underlying cerebral structural change associated with cognitive decline may be a consequence of the cerebral small-vessel disease induced by high blood pressure and may be detected on magnetic resonance imaging as white matter hyperintensities, cerebral microbleeds, lacunar infarcts or enlarged perivascular spaces. The increasing interest in the relationship between hypertension and cognitive decline is based on the fact that blood pressure control in middle-aged subjects may delay or stop the progression of cognitive decline and reduce the risk of dementia in the elderly. Although more evidence is required, several studies on hypertension have shown a beneficial effect on the incidence of dementia.
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Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Eila Monteagudo
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Mónica Doménech
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel Camafort
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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A systematic review of calcium channel blocker use and cognitive decline/dementia in the elderly. J Hypertens 2016; 32:1945-57; discussion 1957-8. [PMID: 25068540 DOI: 10.1097/hjh.0000000000000273] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Treating hypertension in those aged at least 80 years is now recommended; however, the best antihypertensive to choose remains unexplored. Calcium channel blocker (CCB) use has been associated with a decreased risk of incident dementia in a younger hypertensive group but with an increased risk of cognitive decline in the very elderly. Either result could have a large impact on a vulnerable population. The aim of this review was to assess the evidence relating CCB use to later cognitive decline or dementia in the very elderly. METHODS A systematic review of the literature was carried out. The databases Medline, PubMed, Embase and Psychinfo were searched from 1980 to 22 August 2013. Abstracts were reviewed by two independent reviewers and papers meeting the inclusion criteria were extracted. RESULTS One thousand, nine hundred and sixty-eight records were reviewed and 10 articles reporting on nine studies retained and extracted. Data were primarily from cohort studies. Only one reported a randomized controlled trial comparing CCBs with placebo. Populations, comparator groups, follow-up times, outcomes and exposure varied and overall results were mixed. It was not possible to combine all studies, but those reporting Alzheimer's disease outcomes were combined to produce an overall risk ratio of 0.79 (95% confidence interval 0.53-1.17). CONCLUSION At present, there is no clear evidence to suggest that CCB use increases or decreases risk of cognitive decline or dementia in the very elderly. A robust clinical trial is now required to resolve this.
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189
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Wijsman LW, de Craen AJM, Muller M, Sabayan B, Stott D, Ford I, Trompet S, Jukema JW, Westendorp RGJ, Mooijaart SP. Blood Pressure Lowering Medication, Visit-to-Visit Blood Pressure Variability, and Cognitive Function in Old Age. Am J Hypertens 2016; 29:311-8. [PMID: 26156873 DOI: 10.1093/ajh/hpv101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/07/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Visit-to-visit blood pressure (BP) variability is associated with cognitive impairment. We assessed to what extent the association between BP variability and cognitive impairment is mediated by the association of BP lowering medication (BPLM) with both BP variability and cognition. METHODS We studied 5,606 participants from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). BP was measured every 3 months during 3.2 years; BP variability was defined as the SD of BP measurements during follow-up. Cognitive function was assessed at baseline and during follow-up using the Stroop test, Letter-Digit Coding test, and immediate and delayed Picture-Word Learning tests. Multivariate regression models were used with and without adjustments for BPLM to calculate the percentage to which BPLM mediated the association between BP variability and cognition. RESULTS Participants taking calcium antagonists had a higher score in baseline Letter-Digit Coding test (mean difference (95% confidence interval (CI) 0.45 (0.06; 0.88). Participants taking beta-blockers had a steeper decline in Stroop test (additional change per year (95% CI) 0.40 (0.09; 0.70) and Letter-Digit Coding test (0.08 (-0.15; -0.02)). Furthermore, a steeper decline in Stroop test was found in participants taking renin-angiotensin system (RAS) inhibitors (0.50 (0.16; 0.85). Systolic BP variability was higher in participants taking beta-blockers and RAS inhibitors (mean difference in systolic BP variability in mm Hg (95% CI) 0.75 (0.45; 1.04) and 1.37 (1.04; 1.71) respectively). Participants taking diuretics, calcium antagonists, and RAS inhibitors had a higher diastolic BP variability (mean difference in diastolic BP variability in mm Hg (95% CI) 0.27 (0.04; 0.49), 0.37 (0.12; 0.62) and 0.65 (0.37; 0.93) SD, respectively). Beta estimates remained essentially the same when we adjusted for BPLM in the association of BP variability with cognitive function. CONCLUSIONS The association between BP variability and cognitive impairment was not mediated by BPLM.
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Affiliation(s)
- Liselotte W Wijsman
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Majon Muller
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Behnam Sabayan
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - David Stott
- Academic Section of Geriatrics, Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; Institute for Evidence-Based Medicine in Old age, Leiden, The Netherlands.
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Parsons C, Murad MH, Andersen S, Mookadam F, Labonte H. The effect of antihypertensive treatment on the incidence of stroke and cognitive decline in the elderly: a meta-analysis. Future Cardiol 2016; 12:237-48. [PMID: 26919226 DOI: 10.2217/fca.15.90] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the effectiveness of antihypertensives in reducing neurocognitive outcomes in elderly patients. PATIENTS & METHODS We conducted a systematic literature search of randomized trials in which hypertensive patients with a mean age ≥65 years received antihypertensive or control treatment. Outcomes were stroke, transient ischemic attack, cognitive decline and dementia. We included 14 trials for meta-analysis. RESULTS Compared to placebo, antihypertensive treatment reduced the risk of stroke (RR: 0.67 [95% CI: 0.57-0.79]). Reduced risk was significant for transient ischemic attack, fatal stroke, nonfatal stroke and total stroke. There were insufficient data to compare individual agents. CONCLUSION Antihypertensive treatment is associated with a significant reduction in stroke in elderly individuals. Reductions in dementia and cognitive decline were not significant; however, there was short follow-up. Comparative effectiveness evidence is limited.
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Affiliation(s)
- Christine Parsons
- Deptartment of Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Mohammad Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Stuart Andersen
- Deptartment of Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Helene Labonte
- Deptartment of Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
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Inhibited Expression of α 4β 2 Nicotinic Acetylcholine Receptor in Blood Leukocytes of Chinese Patients with Vascular Dementia and in Blood Leukocytes as Well as the Hippocampus of Brain from Ischemic Rats. Cell Mol Neurobiol 2016; 36:1377-1387. [PMID: 26858154 DOI: 10.1007/s10571-016-0337-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
Our present aim was to investigate whether changes in the expression of α4β2 nicotinic acetylcholine receptor (nAChR) in patients with vascular dementia (VaD) and ischemic rats are related to cognitive scores. Blood leukocytes for 59 Chinese patients with VaD (diagnosed on the basis of clinical guidelines) and 31 cases as age-matched controls were examined, and the animal model established employing Pulsinelli's four-vessel occlusion. The levels of α4 and β2 subunit mRNA in leukocytes and the hippocampus were analyzed by real-time PCR, and the protein level in the hippocampus by Western blotting. The mini-mental state examination was utilized to characterize the intellectual capacity of the patients with reference to the DSM IV diagnosis and Hachinski Ischemic Scale score, and the Morris Water Maze test to assess the ability of learning and memory of the rats. In patients, the level of α4 mRNA, but not β2, in blood leukocytes was clearly lowered, which was significantly correlated to their clinical cognitive test scores. Smoking exerted no impact on the level of α4 mRNA in the present study. In the blood leukocytes and the hippocampus of the brains of the ischemic rats, the levels of both α4 and β2 mRNA were lowered, and the proteins of these subunits in the hippocampus were decreased. The changes of α4 and β2 mRNA in blood leukocytes, and their protein levels in the hippocampus were significantly correlated with impaired learning and memory. These findings indicate that alterations in expression of the α4β2 subtype of nAChR may be involved in the molecular mechanism(s) underlying the cognitive deficit associated with VaD.
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192
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Tasmoc A, Donciu MD, Veisa G, Nistor I, Covic A. Increased arterial stiffness predicts cognitive impairment in hemodialysis patients. Hemodial Int 2016; 20:463-72. [DOI: 10.1111/hdi.12406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/27/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Alexandra Tasmoc
- Dialysis and Renal Transplantation Center; “Dr. C. I. Parhon” University Hospital; Iasi Romania
- Faculty of Medicine, Medical Deontology and Bioethics Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Mihaela-Dora Donciu
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Gabriel Veisa
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Ionut Nistor
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
| | - Adrian Covic
- Faculty of Medicine, Nephrology Department; University of Medicine and Pharmacy “Gr. T. Popa”; Iasi Romania
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Iulita MF, Girouard H. Treating Hypertension to Prevent Cognitive Decline and Dementia: Re-Opening the Debate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:447-473. [DOI: 10.1007/5584_2016_98] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Vascular Dementia and Cognitive Impairment. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Hypertension is highly prevalent in older age and accounts for a large proportion of cardiovascular (CV) morbidity and mortality worldwide. Isolated systolic hypertension is more common in the elderly than younger adults and associated with poor outcomes such as cerebrovascular disease and acute coronary events. International guidelines are inconsistent in providing recommendations on optimal blood pressure targets in hypertensive elderly patients as a result of the limited evidence in this population. Evidence from clinical trials supports the use of antihypertensive drugs in hypertensive elderly patients due to benefits in reducing CV disease and mortality. However, elderly participants in these trials may not be typical of elderly patients seen in routine clinical practice, and the potential risks associated with use of antihypertensive drugs in the elderly are not as well studied as younger participants. Therefore, the purpose of this review was to provide a comprehensive summary of the benefits and risks of the use of antihypertensive drugs in elderly patients (aged ≥65 years), highlighting landmark clinical trials and observational studies. We will focus on specific outcomes relating to the benefits and risks of these medications in hypertensive elderly patients, such as CV disease, cognitive decline, dementia, orthostatic hypotension, falls, fractures, cancer and diabetes, in order to provide an update of the most relevant and current evidence to help inform clinical decision-making.
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Affiliation(s)
- D A Butt
- Research Institute, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Family and Community Medicine, The Scarborough Hospital, Scarborough, ON, Canada
| | - P J Harvey
- Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Santos A, Resmini E, Gómez-Ansón B, Crespo I, Granell E, Valassi E, Pires P, Vives-Gilabert Y, Martínez-Momblán MA, de Juan M, Mataró M, Webb SM. Cardiovascular risk and white matter lesions after endocrine control of Cushing's syndrome. Eur J Endocrinol 2015; 173:765-75. [PMID: 26497546 DOI: 10.1530/eje-15-0600] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cushing's syndrome (CS) is associated with high cardiovascular risk. White matter lesions (WML) are common on brain magnetic resonance imaging (MRI) in patients with increased cardiovascular risk. AIM To investigate the relationship between cardiovascular risk, WML, neuropsychological performance and brain volume in CS. DESIGN/METHODS Thirty-eight patients with CS (23 in remission, 15 active) and 38 controls sex-, age- and education-level matched underwent a neuropsychological and clinical evaluation, blood and urine tests and 3Tesla brain MRI. WML were analysed with the Scheltens scale. Ten-year cardiovascular risk (10CVR) and vascular age (VA) were calculated according to an algorithm based on the Framingham heart study. RESULTS Patients in remission had a higher degree of WML than controls and active patients (P<0.001 and P=0.008 respectively), which did not correlate with cognitive performance in any group. WML severity positively correlated with diastolic blood pressure (r=0.659, P=0.001) and duration of hypertension (r=0.478, P=0.021) in patients in remission. Both patient groups (active and in remission) had higher 10CVR (P=0.030, P=0.041) and VA than controls (P=0.013, P=0.039). Neither the 10CVR nor the VA correlated with WML, although both negatively correlated with cognitive function and brain volume in patients in remission (P<0.05). Total brain volume and grey matter volume in both CS patient groups were reduced compared to controls (total volume: active P=0.006, in remission P=0.012; grey matter: active P=0.001, in remission P=0.003), with no differences in white matter volume between groups. CONCLUSIONS Patients in remission of Cushing's syndrome (but not active patients) have more severe white matter lesions than controls, positively correlated with diastolic pressure and duration of hypertension. Ten-year cardiovascular risk and vascular age appear to be negatively correlated with the cognitive function and brain volume in patients in remission of Cushing's syndrome.
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Affiliation(s)
- Alicia Santos
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Eugenia Resmini
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Beatriz Gómez-Ansón
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Iris Crespo
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Esther Granell
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Patricia Pires
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Yolanda Vives-Gilabert
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - M Antonia Martínez-Momblán
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Manuel de Juan
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Maria Mataró
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Sant Antoni Maria Claret n. 167, 08025 Barcelona, SpainNeuroradiology UnitHospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, SpainINNDACYTAvda. Europa, 20, planta baja puerta D 08907, Hospitalet de Llobregat, SpainEscola Universitària d'InfermeriaHospital de Sant Pau. Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of Psychiatry and Clinical PsychobiologyPsychology Faculty, Institute for Brain, Cognition and Behaviour (IR3C), Universitat de Barcelona (UB), Barcelona, Spain
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Brefel-Courbon C. Médicaments et cognition chez le sujet âgé. Therapie 2015. [DOI: 10.2515/therapie/2015038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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198
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Foster-Dingley JC, Moonen JE, de Craen AJ, de Ruijter W, van der Mast RC, van der Grond J. Blood Pressure Is Not Associated With Cerebral Blood Flow in Older Persons. Hypertension 2015; 66:954-60. [DOI: 10.1161/hypertensionaha.115.05799] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Jessica C. Foster-Dingley
- From the Departments of Psychiatry (J.C.F.-D., J.E.F.M., R.C.v.d.M.), Gerontology and Geriatrics (A.J.M.d.C.), Public health and Primary care (W.d.R.), and Radiology (J.v.d.G.), Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, CAPRI, University of Antwerp, Antwerpen, Belgium (R.C.v.d.M.)
| | - Justine E.F. Moonen
- From the Departments of Psychiatry (J.C.F.-D., J.E.F.M., R.C.v.d.M.), Gerontology and Geriatrics (A.J.M.d.C.), Public health and Primary care (W.d.R.), and Radiology (J.v.d.G.), Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, CAPRI, University of Antwerp, Antwerpen, Belgium (R.C.v.d.M.)
| | - Anton J.M. de Craen
- From the Departments of Psychiatry (J.C.F.-D., J.E.F.M., R.C.v.d.M.), Gerontology and Geriatrics (A.J.M.d.C.), Public health and Primary care (W.d.R.), and Radiology (J.v.d.G.), Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, CAPRI, University of Antwerp, Antwerpen, Belgium (R.C.v.d.M.)
| | - Wouter de Ruijter
- From the Departments of Psychiatry (J.C.F.-D., J.E.F.M., R.C.v.d.M.), Gerontology and Geriatrics (A.J.M.d.C.), Public health and Primary care (W.d.R.), and Radiology (J.v.d.G.), Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, CAPRI, University of Antwerp, Antwerpen, Belgium (R.C.v.d.M.)
| | - Roos C. van der Mast
- From the Departments of Psychiatry (J.C.F.-D., J.E.F.M., R.C.v.d.M.), Gerontology and Geriatrics (A.J.M.d.C.), Public health and Primary care (W.d.R.), and Radiology (J.v.d.G.), Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, CAPRI, University of Antwerp, Antwerpen, Belgium (R.C.v.d.M.)
| | - Jeroen van der Grond
- From the Departments of Psychiatry (J.C.F.-D., J.E.F.M., R.C.v.d.M.), Gerontology and Geriatrics (A.J.M.d.C.), Public health and Primary care (W.d.R.), and Radiology (J.v.d.G.), Leiden University Medical Center, Leiden, The Netherlands; and Department of Psychiatry, CAPRI, University of Antwerp, Antwerpen, Belgium (R.C.v.d.M.)
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Abstract
Vascular dementia is one of the most common causes of dementia after Alzheimer's disease, causing around 15% of cases. However, unlike Alzheimer's disease, there are no licensed treatments for vascular dementia. Progress in the specialty has been difficult because of uncertainties over disease classification and diagnostic criteria, controversy over the exact nature of the relation between cerebrovascular pathology and cognitive impairment, and the paucity of identifiable tractable treatment targets. Although there is an established relation between vascular and degenerative Alzheimer's pathology, the mechanistic link between the two has not yet been identified. This Series paper critiques some of the key areas and controversies, summarises treatment trials so far, and makes suggestions for what progress is needed to advance our understanding of pathogenesis and thus maximise opportunities for the search for new and effective management approaches.
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Affiliation(s)
- John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
| | - Alan Thomas
- Biomedical Research Building, Institute of Neuroscience and Newcastle University Institute for Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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