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Du XL, Li Z, Schulz PE. Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer. Front Cardiovasc Med 2023; 10:1136475. [PMID: 37215552 PMCID: PMC10196474 DOI: 10.3389/fcvm.2023.1136475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Background Several previous studies showed that patients who received angiotensin II-stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II-inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors. Objectives To determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007-2015 with follow-up from 2007 to 2016. Methods We identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 17 SEER areas in 2007-2015 with follow-up to 2016, who were free of any diagnosed ADRD at the baseline (within 12 months prior to and 12 months after the date of diagnosis for colorectal cancer). All patients who were defined as having hypertension by ICD diagnosis code or received antihypertensive drugs during this baseline 2-year period were classified into 6 groups based on whether they received angiotensin-II stimulating or inhibiting antihypertensive drugs. Results Crude cumulative incidence rates of AD and ADRD were similar between those who received angiotensin II-stimulating antihypertensive medications (4.3% and 21.7%) and those receiving angiotensin II-inhibiting antihypertensive medications (4.2% and 23.5%). As compared to patients who received angiotensin II-stimulating antihypertensive drugs, those who received angiotensin II-inhibiting antihypertensives were significantly more likely to develop AD (adjusted hazard ratio: 1.15, 95% CI: 1.01-1.32), vascular dementias (1.27, 1.06-1.53), and total ADRD (1.21, 1.14-1.28) after adjusting for potential confounders. These results remained similar after adjusting for medication adherence and considering death as a competing risk. Conclusions The risk of AD and ADRD in patients with hypertension who received angiotensin II-inhibiting antihypertensive medications was higher than in those receiving angiotensin II-stimulating antihypertensive drugs in patients with colorectal cancer.
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Affiliation(s)
- Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Zhuoyun Li
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Paul E. Schulz
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States
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2
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Power MC, Engelman BC, Wei J, Glymour MM. Closing the Gap Between Observational Research and Randomized Controlled Trials for Prevention of Alzheimer Disease and Dementia. Epidemiol Rev 2022; 44:17-28. [PMID: 35442427 PMCID: PMC10362937 DOI: 10.1093/epirev/mxac002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/29/2022] Open
Abstract
Although observational studies have identified modifiable risk factors for Alzheimer disease and related dementias (ADRD), randomized controlled trials (RCTs) of risk factor modification for ADRD prevention have been inconsistent or inconclusive. This finding suggests a need to improve translation between observational studies and RCTs. However, many common features of observational studies reduce their relevance to designing related RCTs. Observational studies routinely differ from RCTs with respect to eligibility criteria, study population, length of follow-up, treatment conditions, outcomes, and effect estimates. Using the motivating example of blood pressure reduction for ADRD prevention, we illustrate the need for a tighter connection between observational studies and RCTs, discuss barriers to using typically reported observational evidence in developing RCTs, and highlight methods that may be used to make observational research more relevant to clinical trial design. We conclude that the questions asked and answered by observational research can be made more relevant to clinical trial design and that better use of observational data may increase the likelihood of successful, or at least definitive, trials. Although we focus on improving translation of observational studies on risk factors for ADRD to RCTs in ADRD prevention, the overarching themes are broadly applicable to many areas of biomedical research.
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Affiliation(s)
- Melinda C Power
- Correspondence to Melinda C. Power, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, NW, Washington, DC 20052 (e-mail: )
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Lai AY, Bazzigaluppi P, Morrone CD, Hill ME, Stefanovic B, McLaurin J. Compromised Cortical-Hippocampal Network Function From Transient Hypertension: Linking Mid-Life Hypertension to Late Life Dementia Risk. Front Neurosci 2022; 16:897206. [PMID: 35812238 PMCID: PMC9260147 DOI: 10.3389/fnins.2022.897206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022] Open
Abstract
Mid-life hypertension is a major risk factor for developing dementia later in life. While anti-hypertensive drugs restore normotension, dementia risk remains above baseline suggesting that brain damage sustained during transient hypertension is irreversible. The current study characterized a rat model of transient hypertension with an extended period of normotensive recovery: F344 rats were treated with L-NG-Nitroarginine methyl ester (L-NAME) for 1 month to induce hypertension then allowed up to 4 months of recovery. With respect to cognitive deficits, comparison between 1 month and 4 months of recovery identified initial deficits in spatial memory that resolved by 4 months post-hypertension; contrastingly, loss of cognitive flexibility did not. The specific cells and brain regions underlying these cognitive deficits were investigated. Irreversible structural damage to the brain was observed in both the prefrontal cortex and the hippocampus, with decreased blood vessel density, myelin and neuronal loss. We then measured theta-gamma phase amplitude coupling as a readout for network function, a potential link between the observed cognitive and pathological deficits. Four months after hypertension, we detected decreased theta-gamma phase amplitude coupling within each brain region and a concurrent increase in baseline connectivity between the two regions reflecting an attempt to maintain function that may account for the improvement in spatial memory. Our results demonstrate that connectivity between prefrontal cortex and hippocampus is a vulnerable network affected by transient hypertension which is not rescued over time; thus demonstrating for the first time a mechanistic link between the long-term effects of transient hypertension and dementia risk.
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Affiliation(s)
- Aaron Y. Lai
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- *Correspondence: Aaron Y. Lai,
| | - Paolo Bazzigaluppi
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | | | - Mary E. Hill
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Bojana Stefanovic
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - JoAnne McLaurin
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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4
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Seshadri S, Caunca MR, Rundek T. Vascular Dementia and Cognitive Impairment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mossanen Parsi M, Duval C, Ariëns RAS. Vascular Dementia and Crosstalk Between the Complement and Coagulation Systems. Front Cardiovasc Med 2021; 8:803169. [PMID: 35004913 PMCID: PMC8733168 DOI: 10.3389/fcvm.2021.803169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 01/12/2023] Open
Abstract
Vascular Dementia (VaD) is a neurocognitive disorder caused by reduced blood flow to the brain tissue, resulting in infarction, and is the second most common type of dementia. The complement and coagulation systems are evolutionary host defence mechanisms activated by acute tissue injury to induce inflammation, clot formation and lysis; recent studies have revealed that these systems are closely interlinked. Overactivation of these systems has been recognised to play a key role in the pathogenesis of neurological disorders such as Alzheimer's disease and multiple sclerosis, however their role in VaD has not yet been extensively reviewed. This review aims to bridge the gap in knowledge by collating current understanding of VaD to enable identification of complement and coagulation components involved in the pathogenesis of this disorder that may have their effects amplified or supressed by crosstalk. Exploration of these mechanisms may unveil novel therapeutic targets or biomarkers that would improve current treatment strategies for VaD.
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Affiliation(s)
| | | | - Robert A. S. Ariëns
- Discovery and Translational Science Department, School of Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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Tran S, Kuruppu S, Rajapakse NW. Chronic Renin-Angiotensin System Activation Induced Neuroinflammation: Common Mechanisms Underlying Hypertension and Dementia? J Alzheimers Dis 2021; 85:943-955. [PMID: 34897090 DOI: 10.3233/jad-215231] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hypertension is a major risk factor for the pathogenesis of vascular dementia and Alzheimer's disease. Chronic activation of the renin-angiotensin system (RAS) contributes substantially to neuroinflammation. We propose that neuroinflammation arising from chronic RAS activation can initiate and potentiate the onset of hypertension and related dementia. Neuroinflammation induced by chronic activation of the RAS plays a key role in the pathogenesis of dementia. Increased levels of pro-inflammatory cytokines tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and transforming growth factor (TGF)-β have been reported in brain tissue of vascular dementia patients and animal models of vascular dementia induced by either angiotensin II infusion or transverse aortic coarctation. It is proposed that neuronal cell death and synaptic dysfunction induced by neuroinflammation lead to cognitive impairment in dementia. The neuroprotective RAS pathway, regulated by angiotensin-converting enzyme 2 (ACE2) which converts angiotensin II into angiotensin-(1-7), can attenuate hypertension and dementia. Furthermore, the use of anti-hypertensive medications in preventing dementia or cognitive decline in hypertensive patients and animal models of dementia have mostly been beneficial. Current evidence suggests a strong link between RAS induced neuroinflammation and the onset of hypertension and dementia, which warrants further investigation. Strategies to counteract an overactive RAS and enhance the neuroprotective arm of the RAS may help prevent or improve cognitive impairment associated with hypertension.
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Affiliation(s)
- Shirley Tran
- School of Biomedical Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Sanjaya Kuruppu
- School of Biomedical Sciences, University of Queensland, St. Lucia, QLD, Australia.,Department of Biochemistry & Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Niwanthi W Rajapakse
- School of Biomedical Sciences, University of Queensland, St. Lucia, QLD, Australia
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7
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Pallangyo P, Mkojera ZS, Komba M, Mgopa LR, Bhalia S, Mayala H, Wibonela S, Misidai N, Swai HJ, Millinga J, Chavala E, Kisenge PR, Janabi M. Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study. BMC Neurol 2021; 21:433. [PMID: 34749692 PMCID: PMC8573988 DOI: 10.1186/s12883-021-02467-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. METHODOLOGY A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. RESULTS A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4-5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2-2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1-2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p = 0.04) to have independent association with cognitive impairment. CONCLUSION This present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.
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Affiliation(s)
- Pedro Pallangyo
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | | | - Makrina Komba
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | | | - Jalack Millinga
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Ester Chavala
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Peter R. Kisenge
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Krishnamurthy V, Sprick JD, Krishnamurthy LC, Barter JD, Turabi A, Hajjar IM, Nocera JR. The Utility of Cerebrovascular Reactivity MRI in Brain Rehabilitation: A Mechanistic Perspective. Front Physiol 2021; 12:642850. [PMID: 33815146 PMCID: PMC8009989 DOI: 10.3389/fphys.2021.642850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cerebrovascular control and its integration with other physiological systems play a key role in the effective maintenance of homeostasis in brain functioning. Maintenance, restoration, and promotion of such a balance are one of the paramount goals of brain rehabilitation and intervention programs. Cerebrovascular reactivity (CVR), an index of cerebrovascular reserve, plays an important role in chemo-regulation of cerebral blood flow. Improved vascular reactivity and cerebral blood flow are important factors in brain rehabilitation to facilitate desired cognitive and functional outcomes. It is widely accepted that CVR is impaired in aging, hypertension, and cerebrovascular diseases and possibly in neurodegenerative syndromes. However, a multitude of physiological factors influence CVR, and thus a comprehensive understanding of underlying mechanisms are needed. We are currently underinformed on which rehabilitation method will improve CVR, and how this information can inform on a patient's prognosis and diagnosis. Implementation of targeted rehabilitation regimes would be the first step to elucidate whether such regimes can modulate CVR and in the process may assist in improving our understanding for the underlying vascular pathophysiology. As such, the high spatial resolution along with whole brain coverage offered by MRI has opened the door to exciting recent developments in CVR MRI. Yet, several challenges currently preclude its potential as an effective diagnostic and prognostic tool in treatment planning and guidance. Understanding these knowledge gaps will ultimately facilitate a deeper understanding for cerebrovascular physiology and its role in brain function and rehabilitation. Based on the lessons learned from our group's past and ongoing neurorehabilitation studies, we present a systematic review of physiological mechanisms that lead to impaired CVR in aging and disease, and how CVR imaging and its further development in the context of brain rehabilitation can add value to the clinical settings.
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Affiliation(s)
- Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Justin D. Sprick
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Physics & Astronomy, Georgia State University, Atlanta, GA, United States
| | - Jolie D. Barter
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Aaminah Turabi
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Ihab M. Hajjar
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Joe R. Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
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Charoenngam N, Rittiphairoj T, Ponvilawan B, Ungprasert P. Patients with psoriasis have a higher risk of dementia: A systematic review and meta-analysis. Indian J Dermatol Venereol Leprol 2021; 87:364-370. [PMID: 33666046 DOI: 10.25259/ijdvl_732_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with psoriasis may have a higher risk of dementia because of the higher inflammatory burden, although results from previous epidemiological studies have been inconsistent. AIMS To determine the association between psoriasis and risk of dementia by pooling the evidence from previous studies. METHODS Potentially eligible studies were identified from Medline and EMBASE databases from inception to July 2019 using a search that comprised terms for "psoriasis" and "dementia." Studies were eligible for the meta-analysis if they were cohort studies that included psoriatic patients and individuals without psoriasis and followed them for incident dementia. Studies were also required to report standardized incidence ratio, hazard risk ratio or relative risk with related 95% confidence intervals (CI) comparing the incidence of dementia between the two cohorts. The retrieved point estimates with standard errors from each study were pooled into the final result by the random-effect model, generic inverse variance method. RESULTS A total of 8,861 articles were identified. After two rounds of independent review by three investigators, we included six cohort studies that met the eligibility criteria in the meta-analysis. The risk of dementia was significantly higher among psoriatic patients than in those without psoriasis with a pooled risk ratio of 1.16 (95% CI, 1.04-1.30; I2 95%). A funnel plot was relatively symmetric and was not suggestive of the presence of publication bias. LIMITATIONS Limited accuracy of diagnosis of psoriasis and dementia as four included studies were coding-based studies, and high statistical heterogeneity among studies. CONCLUSION This systematic review and meta-analysis indicates that psoriatic patients have a significantly elevated risk of developing dementia.
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Affiliation(s)
- Nipith Charoenngam
- Departments of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanitsara Rittiphairoj
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ben Ponvilawan
- Department of Pharmacology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Research and Development, Clinical Epidemiology Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Cerebrovascular damage after midlife transient hypertension in non-transgenic and Alzheimer's disease rats. Brain Res 2021; 1758:147369. [PMID: 33582120 DOI: 10.1016/j.brainres.2021.147369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/20/2022]
Abstract
Hypertension, including transient events, is a major risk factor for developing late-onset dementia and Alzheimer's disease (AD). Anti-hypertensive drugs facilitate restoration of normotension without amelioration of increased dementia risk suggesting that transient hypertensive insults cause irreversible damage. This study characterized the contribution of transient hypertension to sustained brain damage as a function of normal aging and AD. To model transient hypertension, we treated F344TgAD and non-transgenic littermate rats with L-NG-Nitroarginine methyl ester (L-NAME) for one month, ceased treatment and allowed for a month of normotensive recovery. We then examined the changes in the structure and function of the cerebrovasculature, integrity of white matter, and progression of AD pathology. As independent factors, both transient hypertension and AD compromised structural and functional integrity across the vascular bed, while combined effects of hypertension and AD yielded the largest deficits. Combined effects of transient hypertension and AD genotype resulted in loss of cortical myelin particularly in the cingulate cortex which is crucial for cognitive function. Increased cerebral amyloid angiopathy, a prominent pathology of AD, was detected after transient hypertension as were up- and down-regulation of proteins associated with cerebrovascular remodeling - osteopontin, ROCK1 and ROCK2, in F344TgAD rats even 30 days after restoration of normotension. In conclusion, transient hypertension caused permanent cerebrovasculature and brain parenchymal damage in both normal aging and AD. Our results corroborate human studies that have found close correlation between transient hypertension in midlife and white matter lesions later in life outlining vascular pathologies as pathological links to increased risk of dementia.
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den Brok MGHE, van Dalen JW, Abdulrahman H, Larson EB, van Middelaar T, van Gool WA, van Charante EPM, Richard E. Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis. J Am Med Dir Assoc 2021; 22:1386-1395.e15. [PMID: 33460618 DOI: 10.1016/j.jamda.2020.12.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To systematically review and synthesize the evidence on differential associations between antihypertensive medication (AHM) classes and the risk of incident dementia. DESIGN Systematic review and random effects frequentist network meta-analysis. Embase, MEDLINE, and the Cochrane library were searched from origin to December 2019. SETTING AND PARTICIPANTS Randomized controlled trials (RCTs) and prospective cohort studies that compared associations of different AHM classes with incident all-cause dementia and/or Alzheimer's disease over at least 1 year of follow-up. MEASURES All cause dementia and/or Alzheimer's disease. RESULTS Fifteen observational studies and 7 RCTs were included. Data on AHM classes were available for 649,790 participants and dementia occurred in 19,600 (3.02%). Network meta-analysis showed that in observational studies, treatment with either calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs) was associated with lower dementia risks than treatment with other antihypertensives: CCBs vs angiotensin converting enzyme inhibitors (ACE inhibitors) (HR=0.84, 95% CI 0.74-0.95), beta blockers (HR=0.83, 95% CI 0.73-0.95) and diuretics (HR=0.89, 95% CI 0.78-1.01) and ARBs vs ACE inhibitors (HR=0.88, 95% CI 0.81-0.97), beta blockers (HR=0.87, 95% CI 0.77-0.99), and diuretics (HR=0.93, 95% CI 0.83-1.05). There were insufficient RCTs to create a robust network based on randomized data alone. CONCLUSIONS AND IMPLICATIONS Recommending CCBs or ARBs as preferred first-line antihypertensive treatment may significantly reduce the risk of dementia. If corroborated in a randomized setting, these findings reflect a low-cost and scalable opportunity to reduce dementia incidence worldwide.
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Affiliation(s)
- Melina G H E den Brok
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands; Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.
| | - Jan Willem van Dalen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands; Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Hanna Abdulrahman
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands; Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute Seattle, Seattle, WA, USA
| | - Tessa van Middelaar
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands; Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Willem A van Gool
- Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Edo Richard
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands; Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
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Roshani Z, Kamrani AAA, Momtaz YA. Biopsychosocial Predictors of Cognitive Impairment in the Elderly: A Case-control Study. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200705234912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Cognitive impairment is one of the most common diseases in the elderly.
Several studies have already been conducted to identify related factors, but few have explored all
the factors involved in the development of cognitive problems.
Objective:
The present study aimed to identify significant biopsychosocial predictors of cognitive
impairment.
Methods::
This case-control study was conducted on 535 elderly people referred to Shafa Clinic in
the city of Tehran in 2017. The biological factors including serum cholesterol, fasting blood sugar,
systolic and diastolic blood pressure, vitamin D, vitamin B12, serum folate, serum homocysteine,
height, and weight were measured. The psychological variable in this study was a history of depression
that was extracted from the medical records. Social network and social support were measured
by LSNS-6 and MOS-SSS questionnaires. The SPSS version 25 was used to analyze the data.
Results:
The mean age of the control group was 68.4 years (SD = 5.89) and of the case group was
71.5 years (SD = 7.37). The results of multiple logistic regression analysis showed age (AOR=1.05;
CI:1.089-1.016, p≤0.05,), Secondary education (AOR=0.51; CI:0.266-0.990, p<0.05,), Tertiary
education (AOR=0.41; CI:0.212-0.810, p<0.01,), hypertension (AOR=2.16; CI:3.671-1.266,
p<0.01) homocysteine level (AOR=1.09; CI:1.147-1.045, p<0.001,), Hypothyroidism (AOR=0.43;
CI: 0.226 0.820, p<0.001,), and depression (AOR=4.5; CI:7.163-2.822, p<0.001) to be significant
predictors of cognitive impairment.
Conclusion:
Results of this study showed that low education level, high blood pressure, high
level of homocysteine and depression likely increase the risk of cognitive impairment; also, it
was implied that timely screening can identify people at risk. The novelty of the present study is
that it used a combination of the biopsychosocial factors to predict unique predictors of cognitive
impairment.
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Affiliation(s)
- Zahra Roshani
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ahmad-Ali Akbari Kamrani
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Yadollah Abolfathi Momtaz
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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13
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Cosarderelioglu C, Nidadavolu LS, George CJ, Oh ES, Bennett DA, Walston JD, Abadir PM. Brain Renin-Angiotensin System at the Intersect of Physical and Cognitive Frailty. Front Neurosci 2020; 14:586314. [PMID: 33117127 PMCID: PMC7561440 DOI: 10.3389/fnins.2020.586314] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
The renin–angiotensin system (RAS) was initially considered to be part of the endocrine system regulating water and electrolyte balance, systemic vascular resistance, blood pressure, and cardiovascular homeostasis. It was later discovered that intracrine and local forms of RAS exist in the brain apart from the endocrine RAS. This brain-specific RAS plays essential roles in brain homeostasis by acting mainly through four angiotensin receptor subtypes; AT1R, AT2R, MasR, and AT4R. These receptors have opposing effects; AT1R promotes vasoconstriction, proliferation, inflammation, and oxidative stress while AT2R and MasR counteract the effects of AT1R. AT4R is critical for dopamine and acetylcholine release and mediates learning and memory consolidation. Consequently, aging-associated dysregulation of the angiotensin receptor subtypes may lead to adverse clinical outcomes such as Alzheimer’s disease and frailty via excessive oxidative stress, neuroinflammation, endothelial dysfunction, microglial polarization, and alterations in neurotransmitter secretion. In this article, we review the brain RAS from this standpoint. After discussing the functions of individual brain RAS components and their intracellular and intracranial locations, we focus on the relationships among brain RAS, aging, frailty, and specific neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, and vascular cognitive impairment, through oxidative stress, neuroinflammation, and vascular dysfunction. Finally, we discuss the effects of RAS-modulating drugs on the brain RAS and their use in novel treatment approaches.
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Affiliation(s)
- Caglar Cosarderelioglu
- Division of Geriatrics, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey.,Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lolita S Nidadavolu
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Claudene J George
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peter M Abadir
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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14
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Boche D, Nicoll JAR. Invited Review - Understanding cause and effect in Alzheimer's pathophysiology: Implications for clinical trials. Neuropathol Appl Neurobiol 2020; 46:623-640. [PMID: 32643143 DOI: 10.1111/nan.12642] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Abstract
Alzheimer's disease (AD) pathology is multi-faceted, including extracellular accumulation of amyloid-β (Aβ), accumulation of tau within neurons, glial activation and loss of neurons and synapses. From a neuropathological perspective, usually at a single time-point and often at the end-stage of the disease, it is challenging to understand the cause and effect relationships between these components. There are at least four ways of trying to unravel these relationships. First, genetic studies demonstrate mutations that influence Aβ production, but not tau, can initiate AD; whereas genetic variants influencing AD risk are related to innate immunity and lipid metabolism. Second, studies at early time points show that pathology begins decades before the onset of dementia and indicate different anatomical locations for initiation of Aβ and tau accumulation. Third, cause and effect can be studied in experimental models, but most animal models do not fully replicate AD pathology. However, induced pluripotent stem cells (iPSCs) to study live human neurons has introduced a new perspective. Fourth, clinical trials may alter AD pathology giving insights into cause and effect relationships. Therefore, a sequence of (i) neocortical Aβ accumulation followed by (ii) a microglial inflammatory reaction to Aβ, causing neuritic dystrophy which promotes (iii) spread of tau from the limbic system to the neocortex with (iv) progressive tau accumulation and spread resulting in (v) neurodegeneration, explains the evidence. It is proposed that different therapeutic targets are required for different stages of the disease process: Aβ for primary prevention, microglia for secondary prevention, and tau for established disease.
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Affiliation(s)
- D Boche
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J A R Nicoll
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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15
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Sanchez Hoffmann S, Winkler A, Weimar C, Müller-Gerards D, Abramowski J, Moebus S, Jöckel KH, Erbel R, Jokisch M. Blood pressure and cognitive decline - the impact of hypertension over one decade. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:528-542. [PMID: 32673173 DOI: 10.1080/13825585.2020.1792403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Midlife hypertension is a risk factor for cognitive decline in late-life but little is known about the impact of long-term hypertension on cognitive change over time. METHODS We examined blood pressure and cognitive function in 2777 participants (baseline: 2000-2003, 45-75 years, 48.4% men) from the Heinz Nixdorf Recall study. Blood pressure was assessed at three study visits and cognitive function was assessed at both follow-ups (mean follow-up: 5.1 years). Z-score differences in five neuropsychological tests, defining cognitive decline, were derived from linear regression models including age and education. The association of cognitive decline over 5 years and blood pressure over 10 years (classified as: normal blood pressure (>10 years, reference), prevalent hypertension (>10 years), incident hypertension t1 (>5 years), incident hypertension t2 (<5 years), temporary hypertension (at least one hypertensive reading)) was calculated using linear regression models resulting in coefficient b and 95% confidence interval. We calculated interactions with age (linear and with a cutoff at 65 years). RESULTS Participants with prevalent hypertension showed a greater cognitive decline in both verbal memory tests. Incident hypertension t1 was associated with a greater decline in the visuospatial organization test. There was no interaction with age. CONCLUSION This study showed that prevalent high blood pressure over 10 years is related to cognitive decline. Prevalent hypertension with longer exposure time may be more detrimental than temporary hypertension for cognitive function.
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Affiliation(s)
- Sarah Sanchez Hoffmann
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen , Germany
| | - Angela Winkler
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen , Germany
| | - Christian Weimar
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen , Germany
| | - Diana Müller-Gerards
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen , Germany
| | - Jessica Abramowski
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen , Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany
| | - Martha Jokisch
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen , Germany
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16
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Marcum ZA, Hohl SD, Gray SL, Barthold D, Crane PK, Larson EB. Patient Perceptions of Antihypertensive Use as a Dementia Prevention Strategy: A Mixed-Method Analysis of a Web-Based Survey. J Alzheimers Dis 2020; 68:523-529. [PMID: 30814348 DOI: 10.3233/jad-181080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We administered a mixed-method survey to 1,661 patients in a large health system to assess preferences toward antihypertensive use for dementia prevention. If a specific antihypertensive medication was shown to prevent or delay dementia, the vast majority (>90%) of respondents currently taking an antihypertensive reported that they would be willing to take that specific antihypertensive starting as early as mid-life. Concerns reported were potential side effects, lack of evidence of effectiveness, blood pressure being normal or low, and medication cost. Analysis of free-text responses revealed themes of concerns regarding evidence of effectiveness and health priorities.
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Affiliation(s)
| | - Sarah D Hohl
- University of Washington, School of Public Health, Seattle, WA, USA
| | - Shelly L Gray
- University of Washington, School of Pharmacy, Seattle, WA, USA
| | - Doug Barthold
- University of Washington, School of Pharmacy, Seattle, WA, USA
| | - Paul K Crane
- University of Washington, School of Medicine, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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17
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Bazzigaluppi P, Beckett TL, Koletar MM, Hill ME, Lai A, Trivedi A, Thomason L, Dorr A, Gallagher D, Librach CL, Joo IL, McLaurin J, Stefanovic B. Combinatorial Treatment Using Umbilical Cord Perivascular Cells and Aβ Clearance Rescues Vascular Function Following Transient Hypertension in a Rat Model of Alzheimer Disease. Hypertension 2019; 74:1041-1051. [PMID: 31476904 PMCID: PMC6739147 DOI: 10.1161/hypertensionaha.119.13187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Transient hypertension is a risk factor for Alzheimer disease (AD), but the effects of this interaction on brain vasculature are understudied. Addressing vascular pathology is a promising avenue to potentiate the efficacy of treatments for AD. We used arterial spin labeling magnetic resonance imaging to longitudinally assess brain vascular function and immunohistopathology to examine cerebrovascular remodeling and amyloid load. Hypertension was induced for 1 month by administration of l-NG-nitroarginine-methyl-ester in TgF344-AD rats at the prodromal stage. Following hypertension, nontransgenic rats showed transient cerebrovascular changes, whereas TgF344-AD animals exhibited sustained alterations in cerebrovascular function. Human umbilical cord perivascular cells in combination with scyllo-inositol, an inhibitor of Aβ oligomerization, resulted in normalization of hippocampal vascular function and remodeling, in contrast to either treatment alone. Prodromal stage hypertension exacerbates latter AD pathology, and the combination of human umbilical cord perivascular cells with amyloid clearance promotes cerebrovascular functional recovery.
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Affiliation(s)
- Paolo Bazzigaluppi
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Tina L Beckett
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Margaret M Koletar
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Mary E Hill
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Aaron Lai
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Arunachala Trivedi
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Lynsie Thomason
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Adrienne Dorr
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | | | - Clifford L Librach
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.).,Division of Obstetrics and Gynaecology, Laboratory Medicine and Pathobiology (C.L.), University of Toronto, Canada.,CReATe Research Program, Toronto, Canada (D.G., C.L.L.)
| | - Illsung L Joo
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - JoAnne McLaurin
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.)
| | - Bojana Stefanovic
- From the Sunnybrook Research Institute, Toronto, Canada (P.B., T.L.B., M.M.K., M.E.H., A.L., A.T., L.T., A.D., C.L.L., I.L.J., J.M., B.S.).,Department of Medical Biophysics (B.S.), University of Toronto, Canada
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18
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Caruso P, Signori R, Moretti R. Small vessel disease to subcortical dementia: a dynamic model, which interfaces aging, cholinergic dysregulation and the neurovascular unit. Vasc Health Risk Manag 2019; 15:259-281. [PMID: 31496716 PMCID: PMC6689673 DOI: 10.2147/vhrm.s190470] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background Small vessels have the pivotal role for the brain’s autoregulation. The arteriosclerosis-dependent alteration of the brain perfusion is one of the major determinants in small vessel disease. Endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia (sVAD). sVAD increases morbidity and disability. Epidemiological studies have shown that sVAD shares with cerebrovascular disease most of the common risk factors. The molecular basis of this pathology remains controversial. Purpose To detect the possible mechanisms between small vessel disease and sVAD, giving a broad vision on the topic, including pathological aspects, clinical and laboratory findings, metabolic process and cholinergic dysfunction. Methods We searched MEDLINE using different search terms (“vascular dementia”, “subcortical vascular dementia”, “small vessel disease”, “cholinergic afferents”, etc). Publications were selected from the past 20 years. Searches were extended to Embase, Cochrane Library, and LILIACS databases. All searches were done from January 1, 1998 up to January 31, 2018. Results A total of 560 studies showed up, and appropriate studies were included. Associations between traditional vascular risk factors have been isolated. We remarked that SVD and white matter abnormalities are seen frequently with aging and also that vascular and endothelium changes are related with age; the changes can be accelerated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors. Conclusion Small vessel disease and the related dementia are two pathologies that deserve attention for their relevance and impact in clinical practice. Hypertension might be a historical problem for SVD and SVAD, but low pressure might be even more dangerous; CBF regional selective decrease seems to be a critical factor for small vessel disease-related dementia. In those patients, endothelium damage is a super-imposed condition. Several issues are still debatable, and more research is needed.
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Affiliation(s)
- Paola Caruso
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Riccardo Signori
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Rita Moretti
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
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19
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Larsson SC, Markus HS. Does Treating Vascular Risk Factors Prevent Dementia and Alzheimer's Disease? A Systematic Review and Meta-Analysis. J Alzheimers Dis 2019; 64:657-668. [PMID: 29914039 DOI: 10.3233/jad-180288] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Epidemiological evidence has associated Alzheimer's disease (AD) with vascular risk factors (VRFs), but whether treatment of VRFs reduces the incidence of dementia and AD is uncertain. OBJECTIVE To conduct a systematic review and meta-analysis to summarize available data on the impact of treatment of VRFs on dementia and AD incidence. METHODS Pertinent studies published until 1 January 2018 were identified from PubMed. Both randomized controlled trials (RCT) and prospective studies that investigated the impact of treatment of VRFs on dementia or AD incidence were included. RESULTS Eight RCTs and 52 prospective studies were identified. Antihypertensive treatment was associated with a non-significant reduced risk of dementia in RCTs (n = 5; relative risk [RR], 0.84; 95% confidence interval [CI], 0.69-1.02) and prospective studies (n = 3; RR, 0.77; 95% CI, 0.58-1.01) and with reduced AD risk in prospective studies (n = 5; RR = 0.78; 95% CI, 0.66-0.91). In prospective studies, treatment of hyperlipidemia with statins, but not nonstatin lipid-lowering agents, was associated with reduced risk of dementia (n = 17; RR, 0.77; 95% CI, 0.63-0.95) and AD (n = 13; RR, 0.86; 95% CI, 0.80-0.92). The single RCT on statins and dementia incidence showed no association. Data from one RCT and six prospective studies did not support a beneficial impact of antidiabetic drugs or insulin therapy on dementia risk. CONCLUSION Current evidence indicates that antihypertensives and statins might reduce the incidence of dementia and AD. Further trials to determine the effect of VRF on AD are needed.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stroke Research Group, Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Hugh S Markus
- Stroke Research Group, Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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20
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Ostroumova OD, Chernyaeva MS. Antihypertension drugs in prevention of cognition disorder and dementia: focus on calcium channel blockers and diuretics. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-5-79-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Arterial hypertension is associated with elevated risk of cognition decline and vascular dementia development, as the Alzheimer disease development. Therefore, antihypertension therapy might be of preventive value. The review is focused on literary data that witness on, despite controversial, evidence of cerebroprotective action of the range of antihypertension medications. Especially, dihydropyridine calcium antagonists, diuretics and some blockers of renin-angiotensin-aldosterone system. These act not only via blood pressure decrease, but due to additional specific neuroprotective mechanisms. This makes it to consider calcium antagonists and diuretics as a major component of systemic hypertension management, incl. elderly and senile patients, aiming to prevent cognition decline and dementia of various types development.Nitrendipine, among the calcium channels antagonists, and indapamide among diuretics have acquired the broadest evidence that points on their cerebroprotective properties.
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Affiliation(s)
- O. D. Ostroumova
- Evdokimov Moscow State University of Medicine and Dentistry (MSUMD); Sechenov First Moscow State University of the Ministry of Health (the Sechenov University)
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21
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Pezzolo E, Mutlu U, Vernooij MW, Dowlatshahi EA, Gisondi P, Girolomoni G, Nijsten T, Ikram MA, Wakkee M. Psoriasis is not associated with cognition, brain imaging markers, and risk for dementia: The Rotterdam Study. J Am Acad Dermatol 2018; 85:671-680. [PMID: 30092331 DOI: 10.1016/j.jaad.2018.07.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/17/2018] [Accepted: 07/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Based on increased cardiometabolic comorbidities, inflammation, and an overlap in genetics with Alzheimer disease, psoriasis patients might be at risk for cognitive dysfunction and dementia. OBJECTIVE To compare cognition, magnetic resonance imaging (MRI)-markers, and dementia risk in psoriasis and nonpsoriasis participants in the population-based Rotterdam Study. METHODS We identified 318 psoriasis and 9678 nonpsoriasis participants (mean age 66.1 years, 58% women). The association of psoriasis with cognitive function, mild cognitive impairment, and MRI-markers of brain damage was examined by linear and logistic regression. Dementia risk was calculated using Cox regression. Models were adjusted for age, sex, education, and cardiovascular risk factors. RESULTS Cognitive test scores and volumetric, microstructural, focal measures on brain MRI did not differ between psoriasis (28% systemic and ultraviolet treatment) and nonpsoriasis participants, and psoriasis was not associated with mild cognitive impairment (adjusted odd ratio 0.87, 95% confidence interval 0.53-1.43). During 115.000 person-years of follow-up, 810 incident dementia cases (15 among psoriasis patients) occurred. After adjusting for confounders, psoriasis was associated with a lower risk of developing dementia (adjusted hazard ratio 0.50, 95% confidence interval 0.28-0.91). LIMITATIONS Limited dementia cases among psoriasis patients. CONCLUSION In this population-based study, psoriasis was not associated with preclinical markers or higher dementia risk.
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Affiliation(s)
- Elena Pezzolo
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands; Department of Medicine, Section of Dermatology and Venerology, University of Verona, Verona, Italy
| | - Unal Mutlu
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Emmilia A Dowlatshahi
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venerology, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venerology, University of Verona, Verona, Italy
| | - Tamar Nijsten
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands.
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22
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The Impact of Uremic Toxins on Cerebrovascular and Cognitive Disorders. Toxins (Basel) 2018; 10:toxins10070303. [PMID: 30037144 PMCID: PMC6071092 DOI: 10.3390/toxins10070303] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022] Open
Abstract
Individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing cognitive disorders and dementia. Stroke is also highly prevalent in this population and is associated with a higher risk of neurological deterioration, in-hospital mortality, and poor functional outcomes. Evidence from in vitro studies and in vivo animal experiments suggests that accumulation of uremic toxins may contribute to the pathogenesis of stroke and amplify vascular damage, leading to cognitive disorders and dementia. This review summarizes current evidence on the mechanisms by which uremic toxins may favour the occurrence of cerebrovascular diseases and neurological complications in CKD.
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23
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van der Wardt V, Burton JK, Conroy S, Welsh T, Logan P, Taggar J, Tanajewski L, Gladman J. Withdrawal of antihypertensive therapy in people with dementia: feasibility study. Pilot Feasibility Stud 2018; 4:29. [PMID: 29340166 PMCID: PMC5759798 DOI: 10.1186/s40814-017-0221-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/15/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study explored the feasibility of a randomised controlled withdrawal trial of antihypertensive medication in normotensive people with dementia. Feasibility aspects included response, recruitment, exclusion and drop-out rates, suitability of outcome measures, acceptability of study procedures and an indicative economic evaluation for a randomised controlled trial. METHODS A cohort study attempting the withdrawal of antihypertensive drugs where appropriate and a feasibility study of home-based blood pressure monitoring, in people with dementia treated for hypertension, was undertaken. Interviews with participants and carers and an indicative economic evaluation were also undertaken. RESULTS Three hundred and sixty-two primary care practices in the East Midlands were contacted of which only 41 (11% (95%CI 8-15%)) agreed to support the study. These 41 practices posted 940 letters to potential participants. Thirty participants were enrolled in the cohort study of whom 9 were eligible for the antihypertensive withdrawal programme, 20 participated in a home blood pressure monitoring sub-group analysis and 12 took part in an interview study. Twenty-two of those enrolled in the cohort study were followed up at 6 months. The withdrawal programme was acceptable to participants and general practitioners (GPs). The study procedures including assessments and home blood pressure monitoring were acceptable to the participants and their carers. The economic evaluation was not possible. CONCLUSION A withdrawal trial of antihypertensive medication in normotensive people with dementia may not be feasible in the UK because of low recruitment rates.
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Affiliation(s)
- Veronika van der Wardt
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - Jennifer K. Burton
- Centre for Cognitive Ageing and Cognitive Epidemiology & The Alzheimer Scotland Dementia Research Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA UK
| | - Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester, LE1 6TP UK
| | - Tomas Welsh
- Research Institute for the Care of Older People, Combe Parke, Bath, BA1 3NG UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - Jaspal Taggar
- Division of Primary Care School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - Lukasz Tanajewski
- Department of Economics, Kozminski University, Warsaw, Poland
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD UK
| | - John Gladman
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
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Association between Antihypertensive Drug Use and the Incidence of Cognitive Decline and Dementia: A Meta-Analysis of Prospective Cohort Studies. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4368474. [PMID: 29094046 PMCID: PMC5637833 DOI: 10.1155/2017/4368474] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/28/2017] [Accepted: 07/27/2017] [Indexed: 12/20/2022]
Abstract
Background Antihypertensive drug use is inconsistently associated with the risk of dementia, Alzheimer's disease, cognitive impairment, and cognitive decline. Therefore, we conducted a meta-analysis of available prospective cohort studies to summarize the evidence on the strength of these relationships. Methods Three electronic databases including MedLine, Embase, and the Cochrane Library were searched to identify studies from inception to April 2017. Only prospective cohort studies that reported effect estimates with corresponding 95% confidence intervals (CIs) of dementia, Alzheimer's disease, cognitive impairment, and cognitive decline for antihypertensive drug use versus not using antihypertensive drugs were included. Results We included 10 prospective cohort studies reporting data on 30,895 individuals. Overall, participants who received antihypertensive drugs had lower incidence of dementia (relative risk [RR]: 0.86; 95% CI: 0.75–0.99; p = 0.033), while there was no significant effect on the incidence of Alzheimer's disease (RR: 0.83; 95% CI: 0.64–1.09; p = 0.154), cognitive impairment (RR: 0.89; 95% CI: 0.57–1.38; p = 0.596), and cognitive decline (RR: 1.11; 95% CI: 0.86–1.43; p = 0.415). Further, the incidence of Alzheimer's disease might be affected by antihypertensive drug use in participants with specific characteristics. Conclusions Antihypertensive drug use was associated with a significantly reduced risk of dementia, but not with the risk of Alzheimer's disease, cognitive impairment, and cognitive decline.
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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: 26] [Impact Index Per Article: 3.7] [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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26
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Papadopoulos P, Tong XK, Imboden H, Hamel E. Losartan improves cerebrovascular function in a mouse model of Alzheimer's disease with combined overproduction of amyloid-β and transforming growth factor-β1. J Cereb Blood Flow Metab 2017; 37:1959-1970. [PMID: 27389178 PMCID: PMC5464692 DOI: 10.1177/0271678x16658489] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Alterations of the renin-angiotensin system have been implicated in the pathogenesis of Alzheimer's disease. We tested the efficacy of losartan (10 mg/kg/day for three months), a selective angiotensin II type 1 receptor antagonist, in alleviating cerebrovascular and cognitive deficits in double-transgenic mice (six months at endpoint) that overexpress a mutated form of the human amyloid precursor protein (APPSwe,Ind) and a constitutively active form of the transforming growth factor-β1, thereafter named A/T mice. Losartan rescued cerebrovascular reactivity, particularly the dilatory responses, but failed to attenuate astroglial activation and to normalize the neurovascular uncoupling response to sensory stimulation. The cognitive deficits of A/T mice were not restored by losartan nor were the increased brain levels of soluble and insoluble Aβ1-40 and Aβ1-42 peptides normalized. Our results are the first to demonstrate the capacity of losartan to improve cerebrovascular reactivity in an Alzheimer's disease mouse model of combined Aβ-induced vascular oxidative stress and transforming growth factor-β1-mediated vascular fibrosis. These data suggest that losartan may be promising for restoring cerebrovascular function in patients with vascular diseases at risk for vascular dementia or Alzheimer's disease. However, a combined therapy may be warranted for rescuing both vascular and cognitive deficits in a multifaceted pathology like Alzheimer's disease.
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Affiliation(s)
- Panayiota Papadopoulos
- 1 Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Xin-Kang Tong
- 1 Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Hans Imboden
- 2 Institute of Cell Biology, University of Bern, Bern, Switzerland
| | - Edith Hamel
- 1 Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
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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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Rebeck GW. The role of APOE on lipid homeostasis and inflammation in normal brains. J Lipid Res 2017; 58:1493-1499. [PMID: 28258087 DOI: 10.1194/jlr.r075408] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/02/2017] [Indexed: 12/24/2022] Open
Abstract
The role of APOE in the risk of Alzheimer's disease (AD) has largely focused on its effects on AD pathological processes. However, there are increasing data that APOE genotype affects processes in normal brains. Studies of young cognitively normal humans show effects of APOE genotype on brain structure and activity. Studies of normal APOE knock-in mice show effects of APOE genotype on brain structure, neuronal markers, and behavior. APOE interactions with molecules important for lipid efflux and lipid endocytosis underlie effects of APOE genotype on neuroinflammation and lipoprotein composition. These effects provide important targets for new therapies for reduction of the risk of AD before any signs of pathogenesis.
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Affiliation(s)
- G William Rebeck
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC.
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Tonsekar PP, Jiang SS, Yue G. Periodontal disease, tooth loss and dementia: Is there a link? A systematic review. Gerodontology 2017; 34:151-163. [DOI: 10.1111/ger.12261] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Pallavi P. Tonsekar
- Department of Periodontics; Rutgers School of Dental Medicine; Newark NJ USA
| | - Shuying S. Jiang
- Institutional Assessment and Quality Improvement; Rutgers School of Dental Medicine; Newark NJ USA
| | - Gang Yue
- Department of Periodontics; Rutgers School of Dental Medicine; Newark NJ USA
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Srinivasan V, Braidy N, Chan EKW, Xu YH, Chan DKY. Genetic and environmental factors in vascular dementia: an update of blood brain barrier dysfunction. Clin Exp Pharmacol Physiol 2016; 43:515-21. [PMID: 26859837 DOI: 10.1111/1440-1681.12558] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
Vascular dementia (VaD) describes a combination of both cognitive and behavioural manifestations associated with variable brain lesions of vascular origin. While vascular risk factors have been implicated in VaD, the relationship is most evident when the factors are considered together and not individually. This review will examine the significance of the integrity of blood brain barrier (BBB) tight junction (TJ) proteins - occludin and claudins in the pathophysiology of VaD. Specifically, some of the genetic contributors to VaD, namely those responsible for the integrity of the BBB, will be reviewed in detail. Moreover, environmental factors will be considered in conjunction with these genes to examine how the interaction of environmental and genetic factors contributes to one's susceptibility to VaD.
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Affiliation(s)
- Vivek Srinivasan
- Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Nady Braidy
- Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, Australia.,Ingham Institute, Liverpool, Australia.,School of Psychiatry, Centre for Healthy Brain Ageing, Sydney, Australia
| | - Eunice K W Chan
- Faculty of Medicine, Western Sydney University, Macarthur, Australia
| | - Ying-Hua Xu
- Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Ingham Institute, Liverpool, Australia
| | - Daniel K Y Chan
- Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Ingham Institute, Liverpool, Australia
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Afsar B, Sag AA, Yalcin CE, Kaya E, Siriopol D, Goldsmith D, Covic A, Kanbay M. Brain-kidney cross-talk: Definition and emerging evidence. Eur J Intern Med 2016; 36:7-12. [PMID: 27531628 DOI: 10.1016/j.ejim.2016.07.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 12/12/2022]
Abstract
Cross-talk is broadly defined as endogenous homeostatic signaling between vital organs such as the heart, kidneys and brain. Kidney-brain cross-talk remains an area with excitingly few publications despite its purported clinical relevance in the management of currently undertreated conditions such as resistant hypertension. Therefore, this review aims to establish an organ-specific definition for kidney-brain cross-talk and review the available and forthcoming literature on this topic.
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Affiliation(s)
- Baris Afsar
- Department of Medicine, Division of Nephrology, Konya Numune State Hospital, Konya, Turkey
| | - Alan A Sag
- Department of Radiology, Division of Interventional Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Can Ege Yalcin
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Eren Kaya
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Dimitrie Siriopol
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - David Goldsmith
- Renal and Transplantation Department, Guy's and St Thomas' Hospitals, London, UK
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
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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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34
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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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Deniz Ç, Çelik Y, Özdemir Gültekin T, Baran GE, Deniz Ç, Asil T. Evaluation and follow-up of cognitive functions in patients with minor stroke and transient ischemic attack. Neuropsychiatr Dis Treat 2016; 12:2039-48. [PMID: 27578977 PMCID: PMC4998017 DOI: 10.2147/ndt.s102193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to examine the incidence of cognitive impairment among patients with stroke, the associated risk factors, progression of the cognitive impairment, and the association between the localization of the lesion(s) as detected by magnetic resonance imaging and the affected areas of cognitive function. METHODS A total of 40 patients over 18 years of age enduring a transient ischemic stroke or minor stroke within the past 3 months who had a minimum life expectancy of 1 year were included in this study. Same number, age-, and sex-matched individuals were included as controls. Patients were inquired on the presence of risk factors for stroke. A series of neuropsychological test batteries were administered in patient and control subjects for assessing cognitive functions. These tests were readministered at 6 and 12 months of follow-up to assess the progression of cognitive functions. RESULTS In this study among the patients with stroke, a significant impairment was seen in multiple cognitive functional tests following ischemic stroke as compared to control groups. The most common risk factors for stroke included hypertension (72.5%), hyperlipidemia, and cigarette smoking. The number of cognitive domains with an impairment was highest (in four cognitive tests) among those with coronary artery disease and atrial fibrillation, followed by those who had a >50% stenosis in Doppler (three cognitive tests). These findings suggest that the frequency of risk factors associated with stroke does not correlate with the frequency of risk factors associated with cognitive dysfunction. The stroke localizations were classified among the patients with stroke and reviewed in accordance with cognitive impairment. CONCLUSION Neuropsychological tests, clinical findings, and imaging studies should be used to document the poststroke cognitive dysfunction.
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Affiliation(s)
- Çiğdem Deniz
- Department of Neurology, Faculty of Medicine, Bezmialem Vakıf University, ˙Istanbul
| | - Yahya Çelik
- Department of Neurology, Faculty of Medicine, Trakya University, Edirne
| | | | - Gozde Eryiğit Baran
- Department of Neurology, Faculty of Medicine, Bezmialem Vakıf University, ˙Istanbul
| | - Çağla Deniz
- Department of Neurology, Avrupa Hospital, Adana, Turkey
| | - Talip Asil
- Department of Neurology, Faculty of Medicine, Bezmialem Vakıf University, ˙Istanbul
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Olsen I, Singhrao SK. Can oral infection be a risk factor for Alzheimer's disease? J Oral Microbiol 2015; 7:29143. [PMID: 26385886 PMCID: PMC4575419 DOI: 10.3402/jom.v7.29143] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 07/21/2015] [Accepted: 08/21/2015] [Indexed: 12/19/2022] Open
Abstract
Alzheimer's disease (AD) is a scourge of longevity that will drain enormous resources from public health budgets in the future. Currently, there is no diagnostic biomarker and/or treatment for this most common form of dementia in humans. AD can be of early familial-onset or sporadic with a late-onset. Apart from the two main hallmarks, amyloid-beta and neurofibrillary tangles, inflammation is a characteristic feature of AD neuropathology. Inflammation may be caused by a local central nervous system insult and/or by peripheral infections. Numerous microorganisms are suspected in AD brains ranging from bacteria (mainly oral and non-oral Treponema species), viruses (herpes simplex type I), and yeasts (Candida species). A causal relationship between periodontal pathogens and non-oral Treponema species of bacteria has been proposed via the amyloid-beta and inflammatory links. Periodontitis constitutes a peripheral oral infection that can provide the brain with intact bacteria and virulence factors and inflammatory mediators due to daily, transient bacteremias. If and when genetic risk factors meet environmental risk factors in the brain, disease is expressed, in which neurocognition may be impacted, leading to the development of dementia. To achieve the goal of finding a diagnostic biomarker and possible prophylactic treatment for AD, there is an initial need to solve the etiological puzzle contributing to its pathogenesis. This review therefore addresses oral infection as the plausible etiology of late-onset AD (LOAD).
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Affiliation(s)
- Ingar Olsen
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway;
| | - Sim K Singhrao
- Oral & Dental Sciences Research Group, College of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
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Day RJ, Mason MJ, Thomas C, Poon WW, Rohn TT. Caspase-Cleaved Tau Co-Localizes with Early Tangle Markers in the Human Vascular Dementia Brain. PLoS One 2015; 10:e0132637. [PMID: 26161867 PMCID: PMC4498690 DOI: 10.1371/journal.pone.0132637] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/16/2015] [Indexed: 02/01/2023] Open
Abstract
Vascular dementia (VaD) is the second most common form of dementia in the United States and is characterized as a cerebral vessel vascular disease that leads to ischemic episodes. Whereas the relationship between caspase-cleaved tau and neurofibrillary tangles (NFTs) in Alzheimer's disease (AD) has been previously described, whether caspase activation and cleavage of tau occurs in VaD is presently unknown. To investigate a potential role for caspase-cleaved tau in VaD, we analyzed seven confirmed cases of VaD by immunohistochemistry utilizing a well-characterized antibody that specifically detects caspase-cleaved tau truncated at Asp421. Application of this antibody (TauC3) revealed consistent labeling within NFTs, dystrophic neurites within plaque-rich regions and corpora amylacea (CA) in the human VaD brain. Labeling of CA by the TauC3 antibody was widespread throughout the hippocampus proper, was significantly higher compared to age matched controls, and co-localized with ubiquitin. Staining of the TauC3 antibody co-localized with MC-1, AT8, and PHF-1 within NFTs. Quantitative analysis indicated that roughly 90% of PHF-1-labeled NFTs contained caspase-cleaved tau. In addition, we documented the presence of active caspase-3 within plaques, blood vessels and pretangle neurons that co-localized with TauC3. Collectively, these data support a role for the activation of caspase-3 and proteolytic cleavage of TauC3 in VaD providing further support for the involvement of this family of proteases in NFT pathology.
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Affiliation(s)
- Ryan J. Day
- Department of Biological Sciences, Science Building, Room 228, Boise State University, Boise, Idaho, 83725, United States of America
| | - Maria J. Mason
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, 92697, United States of America
| | - Chloe Thomas
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, 92697, United States of America
| | - Wayne W. Poon
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, 92697, United States of America
| | - Troy T. Rohn
- Department of Biological Sciences, Science Building, Room 228, Boise State University, Boise, Idaho, 83725, United States of America
- * E-mail:
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Warchol-Celinska E, Styczynska M, Prejbisz A, Przybylowska K, Chodakowska-Zebrowska M, Kurjata P, Piotrowski W, Polakowska M, Kabat M, Zdrojewski T, Drygas W, Januszewicz A, Barcikowska M. Hypertension in patients with Alzheimer's disease--prevalence, characteristics, and impact on clinical outcome. Experience of one neurology center in Poland. ACTA ACUST UNITED AC 2015. [PMID: 26210391 DOI: 10.1016/j.jash.2015.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of the study was to evaluate hypertension (HT) prevalence, characteristics, and impact on clinical outcome in patients with Alzheimer's disease (AD). We evaluated 701 patients with AD (249 males, 452 females, and mean age 74.9 ± 7.5 years). As a group representing general population matched with regard to age, education level, and place of residence, we included 762 subjects (438 males, 324 females, and mean age 74.7 ± 4.4 years) from the Polish National Multicenter Health Survey (WOBASZ) studies. The patients with AD were characterized by lower systolic blood pressure (BP) and diastolic BP values (134 ± 21 vs. 151 ± 23 mm Hg, P < .001 and 77 ± 11 vs. 86 ± 12 mm Hg, P < .001, respectively) as well as lower HT prevalence (66% vs. 78.6%, P < .001) compared with the WOBASZ group. In long-term follow-up of AD group, HT and BP levels were not associated with the decline in cognitive functions nor the increased risk of death. Patients with AD were characterized by lower prevalence of HT and other vascular risk factors. BP levels and HT had no impact on clinical outcome.
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Affiliation(s)
| | - Maria Styczynska
- Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | | | | | | | - Pawel Kurjata
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Walerian Piotrowski
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Maria Polakowska
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Marek Kabat
- Department of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | | | - Maria Barcikowska
- Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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Abstract
OPINION STATEMENT Cerebrovascular disease (CVD) is an important cause of cognitive dysfunction and dementia. The term vascular cognitive impairment (VCI) is used to describe the entire spectrum of cognitive dysfunction-ranging from mild impairment to dementia-attributable to all forms of cerebrovascular disease. Accurate assessment and management of vascular risk factors are a top priority in the treatment of VCI, particularly early in the disease when prevention strategies may prove to be more effective. There are limited treatment options to improve cognition and function in VCI. Several acetylcholinesterase inhibitors and the NMDA receptor antagonist memantine have been studied in large, well-designed trials. These agents are safe and provide modest cognitive benefits in vascular dementia (VaD) but have demonstrated inconsistent efficacy on functional measures. Other therapies, such as aspirin, calcium channel blockers, and vitamin supplementation, have less evidence to support their use in improving cognition in VCI. Although primary prevention trials suggest that treatment of hypertension, adherence to a Mediterranean diet, physical activity, and smoking cessation may reduce the risk of cognitive decline, there is limited evidence regarding these interventions in helping improve cognition in VCI. The pathophysiology and treatment of cerebral autosomal dominant arteriopathy with subcortical infarcts (CADASIL), cerebral amyloid angiopathy (CAA), and subcortical white matter disease (SWMD) deserves special consideration.
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Affiliation(s)
- Aaron Ritter
- Department of Neurology, Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 West Bonneville Avenue, Las Vegas, NV, 89106, USA,
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Rouch L, Cestac P, Hanon O, Cool C, Helmer C, Bouhanick B, Chamontin B, Dartigues JF, Vellas B, Andrieu S. Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs 2015; 29:113-30. [PMID: 25700645 DOI: 10.1007/s40263-015-0230-6] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic hypertension, particularly midlife high blood pressure, has been associated with an increased risk for cognitive decline and dementia. In this context, antihypertensive drugs might have a preventive effect, but the association remains poorly understood. OBJECTIVES The aim of this systematic review was to examine all published findings that investigated this relationship and discuss the mechanisms underlying the potential benefits of antihypertensive medication use. METHODS A literature search was conducted using MEDLINE, Embase, and the Cochrane Library for publications from 1990 onwards mentioning hypertension, antihypertensive drugs, cognitive decline, and dementia. RESULTS A total of 38 relevant publications, corresponding to 18 longitudinal studies, 11 randomized controlled trials, and nine meta-analyses were identified from the 10,251 articles retrieved in the literature search. In total, 1,346,176 subjects were included in these studies; the average age was 74 years. In the seven longitudinal studies assessing the effect of antihypertensive medication on cognitive impairment or cognitive decline, antihypertensive drugs appeared to be beneficial. Of the 11 longitudinal studies that assessed the effect of antihypertensive medication on incidence of dementia, only three did not find a significant protective effect. Antihypertensive medication could decrease the risk of not only vascular dementia but also Alzheimer's disease. Four randomized controlled trials showed a potentially preventive effect of antihypertensive drugs on the incidence of dementia or cognitive decline: SYST-EUR (Systolic Hypertension in Europe Study) I and II, with a 55% reduction in dementia risk (3.3 vs. 7.4 cases per 1,000 patient years; p<0.001); HOPE (Heart Outcomes Prevention Evaluation), with a 41% reduction in cognitive decline associated with stroke (95% confidence interval [CI] 6-63); and PROGRESS (Perindopril Protection against Recurrent Stroke Study), with a 19% reduction in cognitive decline (95% CI 4-32; p=0.01). Meta-analyses have sometimes produced conflicting results, but this may be due to methodological considerations. The lack of homogeneity across study designs, patient populations, exposition, outcomes, and duration of follow-up are the most important methodological limitations that might explain the discrepancies between some of these studies. CONCLUSION Antihypertensive drugs, particularly calcium channel blockers and renin-angiotensin system blockers, may be beneficial in preventing cognitive decline and dementia. However, further randomized controlled trials with longer periods of follow-up and cognition as the primary outcome are needed to confirm these findings.
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Wharton W, Gleason CE, Dowling NM, Carlsson CM, Brinton EA, Santoro MN, Neal-Perry G, Taylor H, Naftolin F, Lobo RA, Merriam G, Manson JE, Cedars MI, Miller VM, Black DM, Budoff M, Hodis HN, Harman SM, Asthana S. The KEEPS-Cognitive and Affective Study: baseline associations between vascular risk factors and cognition. J Alzheimers Dis 2015; 40:331-41. [PMID: 24430001 DOI: 10.3233/jad-130245] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Midlife vascular risk factors influence later cognitive decline and Alzheimer's disease (AD). The decrease in serum estradiol levels during menopause has been associated with cognitive impairment and increased vascular risk, such as high blood pressure (BP), which independently contributes to cognitive dysfunction and AD. We describe the extent to which vascular risk factors relate to cognition in healthy, middle-aged, recently postmenopausal women enrolled in the Kronos Early Estrogen Prevention Cognitive and Affective Study (KEEPS-Cog) at baseline. KEEPS-Cog is a double-blind, randomized, placebo-controlled, parallel group, clinical trial, investigating the efficacy of low-dose, transdermal 17β-estradiol and oral conjugated equine estrogen on cognition. All results are cross-sectional and represent baseline data only. Analyses confirm that the KEEPS-Cog cohort (n = 571) was middle aged (mean 52.7 years, range 42-59 years), healthy, and free of cognitive dysfunction. Higher systolic BP was weakly related to poorer performance in auditory working memory and attention (p = 0.004; adjusted for multiple comparisons p = 0.10). This relationship was not associated with endogenous hormone levels, and systolic BP was not related to any other cognitive domain. BP levels may be more sensitive than other vascular risk factors in detecting subtle differences in cognitive task performance in healthy, recently menopausal women. Lower BP early in menopause may affect cognitive domains known to be associated with AD.
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Affiliation(s)
- Whitney Wharton
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Emory Alzheimer's Disease Research Center, (ADRC) Atlanta, GA, USA
| | - Carey E Gleason
- Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA
| | - N Maritza Dowling
- Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA University of Wisconsin, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Cynthia M Carlsson
- Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA
| | - Eliot A Brinton
- Cardiovascular Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M Nanette Santoro
- Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Hugh Taylor
- Obstetrics & Gynecology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Rogerio A Lobo
- Obstetrics & Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - George Merriam
- VA Puget Sound Health Care System and Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA
| | - Joann E Manson
- Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelle I Cedars
- Obstetrics & Gynecology, University of California at San Francisco, San Francisco, CA, USA
| | - Virginia M Miller
- Surgery & Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Dennis M Black
- Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Matthew Budoff
- Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Howard N Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA, USA
| | - S Mitchell Harman
- Kronos Longevity Research Institute and Phoenix VA Medical Center, Phoenix, AZ, USA
| | - Sanjay Asthana
- Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA
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Cognitive impairment and cardiovascular diseases in the elderly. A heart-brain continuum hypothesis. Ageing Res Rev 2014; 18:41-52. [PMID: 25107566 DOI: 10.1016/j.arr.2014.07.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/09/2014] [Accepted: 07/17/2014] [Indexed: 12/30/2022]
Abstract
The aging population is increasing and, therefore, a higher prevalence of cardiac disease is emerging; including hypertension, coronary artery disease, atrial fibrillation and chronic heart failure. Large cohort studies have revealed a relationship among increased risk for cognitive impairment and dementia in cardiovascular diseases probably due to embolic stroke or chronic cerebral hypoperfusion. Thus, the aim of the present review is to overview the studies that investigate the presence and/or the development of cognitive impairments and dementia in patients with varied types of cardiovascular disease. Finally, a continuum among hypertension, coronary artery disease, atrial fibrillation and chronic heart failure with to the development of cognitive impairment and progression to dementia has been hypothesized.
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Morris AWJ, Carare RO, Schreiber S, Hawkes CA. The Cerebrovascular Basement Membrane: Role in the Clearance of β-amyloid and Cerebral Amyloid Angiopathy. Front Aging Neurosci 2014; 6:251. [PMID: 25285078 PMCID: PMC4168721 DOI: 10.3389/fnagi.2014.00251] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/05/2014] [Indexed: 11/13/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA), the accumulation of β-amyloid (Aβ) peptides in the walls of cerebral blood vessels, is observed in the majority of Alzheimer’s disease (AD) brains and is thought to be due to a failure of the aging brain to clear Aβ. Perivascular drainage of Aβ along cerebrovascular basement membranes (CVBMs) is one of the mechanisms by which Aβ is removed from the brain. CVBMs are specialized sheets of extracellular matrix that provide structural and functional support for cerebral blood vessels. Changes in CVBM composition and structure are observed in the aged and AD brain and may contribute to the development and progression of CAA. This review summarizes the properties of the CVBM, its role in mediating clearance of interstitial fluids and solutes from the brain, and evidence supporting a role for CVBM in the etiology of CAA.
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Affiliation(s)
- Alan W J Morris
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton , Southampton , UK
| | - Roxana O Carare
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton , Southampton , UK
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University , Magdeburg , Germany ; German Center for Neurodegenerative Diseases (DZNE), Helmholtz Association , Magdeburg , Germany
| | - Cheryl A Hawkes
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton , Southampton , UK
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Sukhorukov AY, Nirvanappa AC, Swamy J, Ioffe SL, Nanjunda Swamy S, Basappa, Rangappa KS. Synthesis and characterization of novel 1,2-oxazine-based small molecules that targets acetylcholinesterase. Bioorg Med Chem Lett 2014; 24:3618-21. [PMID: 24909082 DOI: 10.1016/j.bmcl.2014.05.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/05/2014] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
Abstract
Thirteen 2-oxazine-based small molecules were synthesized targeting 5-lipoxygenase (LOX), and acetylcholinesterase (AChE). The test revealed that the newly synthesized compounds had potent inhibition towards both 5-LOX and AChE in lower micro molar concentration. Among the tested compounds, the most active compound, 2-[(2-acetyl-6,6-dimethyl-4-phenyl-5,6-dihydro-2H-1,2-oxazin-3-yl)methyl]-1H-isoindole-1,3(2H)-dione (2a) showed inhibitory activity towards 5-LOX and AChE with an IC50 values of 1.88, and 2.5 μM, respectively. Further, the in silico molecular docking studies revealed that the compound 2a bound to the catalytic domain of AChE strongly with a highest CDOCKER score of -1.18 kcal/mol when compared to other compounds of the same series. Additionally, 2a showed a good lipophilicity (logP=2.66), suggesting a potential ability to penetrate the blood-brain-barrier. These initial pharmacological data revealed that the compound 2a could serve as a drug-seed in developing anti-Alzheimer's agents.
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Affiliation(s)
- Alexey Yu Sukhorukov
- N.D. Zelinsky Institute of Organic Chemistry, Leninsky Prospect, 47, Moscow 119991, Russia
| | - Anilkumar C Nirvanappa
- Laboratory of Chemical Biology, Department of Chemistry, Bangalore University, Palace Road, Bangalore 560001, India
| | - Jagadish Swamy
- Department of Chemistry, University of Mysore, Manasagangotri, Mysore 560001, India
| | - Sema L Ioffe
- N.D. Zelinsky Institute of Organic Chemistry, Leninsky Prospect, 47, Moscow 119991, Russia
| | - Shivananju Nanjunda Swamy
- Department of Biotechnology, Sri Jayachamarajendra College of Engineering, JSS, Technical Institutions Campus, Mysore 570006, India
| | - Basappa
- Laboratory of Chemical Biology, Department of Chemistry, Bangalore University, Palace Road, Bangalore 560001, India.
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Chuang YF, Breitner JCS, Chiu YL, Khachaturian A, Hayden K, Corcoran C, Tschanz J, Norton M, Munger R, Welsh-Bohmer K, Zandi PP. Use of diuretics is associated with reduced risk of Alzheimer's disease: the Cache County Study. Neurobiol Aging 2014; 35:2429-2435. [PMID: 24910391 DOI: 10.1016/j.neurobiolaging.2014.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/27/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
Although the use of antihypertensive medications has been associated with reduced risk of Alzheimer's disease (AD), it remains unclear which class provides the most benefit. The Cache County Study of Memory Health and Aging is a prospective longitudinal cohort study of dementing illnesses among the elderly population of Cache County, Utah. Using waves I to IV data of the Cache County Study, 3417 participants had a mean of 7.1 years of follow-up. Time-varying use of antihypertensive medications including different class of diuretics, angiotensin converting enzyme inhibitors, β-blockers, and calcium channel blockers was used to predict the incidence of AD using Cox proportional hazards analyses. During follow-up, 325 AD cases were ascertained with a total of 23,590 person-years. Use of any antihypertensive medication was associated with lower incidence of AD (adjusted hazard ratio [aHR], 0.77; 95% confidence interval [CI], 0.61-0.97). Among different classes of antihypertensive medications, thiazide (aHR, 0.7; 95% CI, 0.53-0.93), and potassium-sparing diuretics (aHR, 0.69; 95% CI, 0.48-0.99) were associated with the greatest reduction of AD risk. Thiazide and potassium-sparing diuretics were associated with decreased risk of AD. The inverse association of potassium-sparing diuretics confirms an earlier finding in this cohort, now with longer follow-up, and merits further investigation.
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Affiliation(s)
- Yi-Fang Chuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John C S Breitner
- Department of Psychiatry, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Yen-Ling Chiu
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ara Khachaturian
- National Supercomputing Center (NSCEE) for Energy and the Environment, University of Nevada, Las Vegas, NV, USA
| | - Kathleen Hayden
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Chris Corcoran
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Mathematics and Statistics, Utah State University, Logan, UT, USA
| | - JoAnn Tschanz
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Psychology, Utah State University, Logan, UT, USA
| | - Maria Norton
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Psychology, Utah State University, Logan, UT, USA; Department of Family, Consumer, and Human Development, Utah State University, Logan, UT, USA
| | - Ron Munger
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | - Kathleen Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Tzourio C, Laurent S, Debette S. Is hypertension associated with an accelerated aging of the brain? Hypertension 2014; 63:894-903. [PMID: 24566080 DOI: 10.1161/hypertensionaha.113.00147] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Christophe Tzourio
- Inserm U897, University of Bordeaux, 146 rue léo Saignat-Case 11, 33076 Bordeaux Cedex, France.
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Fournier A, Oprisiu-Fournier R, Serot JM, Godefroy O, Achard JM, Faure S, Mazouz H, Temmar M, Albu A, Bordet R, Hanon O, Gueyffier F, Wang J, Black S, Sato N. Prevention of dementia by antihypertensive drugs: how AT1-receptor-blockers and dihydropyridines better prevent dementia in hypertensive patients than thiazides and ACE-inhibitors. Expert Rev Neurother 2014; 9:1413-31. [DOI: 10.1586/ern.09.89] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Propranolol reduces cognitive deficits, amyloid and tau pathology in Alzheimer's transgenic mice. Int J Neuropsychopharmacol 2013; 16:2245-57. [PMID: 23768694 DOI: 10.1017/s1461145713000631] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The efficacy of antihypertensive agents in Alzheimer's disease (AD) is controversial. It has been tested here whether some antihypertensive drugs might influence AD through mechanisms independent of blood pressure-lowering activity. The effects of treatment with the antihypertensive propranolol on cognition and AD-related markers have been studied in the Tg2576 mouse model of AD. Propranolol, at a lower dose than that used as antihypertensive (5 mg/kg, 6 wk), attenuated cognitive impairments shown by Tg2576 mice aged 9 months in the novel object recognition and fear conditioning tests. Propranolol was also able to counteract the increases in hippocampal levels of Aβ(42) present in Tg2576 mice. This effect was accompanied by an increased expression of insulin degrading enzyme. Changes in markers of synaptic pathology, as shown by decreases in phosphorylation of Akt and in the expression of BDNF in Tg2676 mice, were also counteracted by propranolol treatment. Tau hyperphosphorylation shown by Tg2576 mice was also decreased in the hippocampus of propranolol-treated mice, an effect probably related to an increase of GSK3β phosphorylation (inactive form) and a decreased JNK1 expression. Overall, these data further strengthen the potential of propranolol as a therapeutic agent for AD.
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