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Tripathi R, Tripathi S, Pandey N, Srivastava A, Usman K, Ali W, Tiwari S. Cognitive status of older adults with diabetes mellitus, hypertension, and dyslipidemia on Hindi Cognitive Screening Test and Saint Louis University Mental State. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nocito C, Lubinsky C, Hand M, Khan S, Patel T, Seliga A, Winfield M, Zuluaga-Ramirez V, Fernandes N, Shi X, Unterwald EM, Persidsky Y, Sriram U. Centrally Acting Angiotensin-Converting Enzyme Inhibitor Suppresses Type I Interferon Responses and Decreases Inflammation in the Periphery and the CNS in Lupus-Prone Mice. Front Immunol 2020; 11:573677. [PMID: 33042154 PMCID: PMC7522287 DOI: 10.3389/fimmu.2020.573677] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multi-organ damage. Neuropsychiatric lupus (NPSLE) is one of the most common manifestations of human SLE, often causing depression. Interferon-α (IFNα) is a central mediator in disease pathogenesis. Administration of IFNα to patients with chronic viral infections or cancers causes depressive symptoms. Angiotensin-converting enzyme (ACE) is part of the kallikrein-kinin/renin-angiotensin (KKS/RAS) system that regulates many physiological processes, including inflammation, and brain functions. It is known that ACE degrades bradykinin (BK) into inactive peptides. We have previously shown in an in vitro model of mouse bone-marrow-derived dendritic cells (BMDC) and human peripheral blood mononuclear cells that captopril (a centrally acting ACE inhibitor-ACEi) suppressed Type I IFN responsive gene (IRG) expression. In this report, we used the MRL/lpr lupus-prone mouse model, an established model to study NPSLE, to determine the in vivo effects of captopril on Type I IFN and associated immune responses in the periphery and brain and effects on behavior. Administering captopril to MRL/lpr mice decreased expression of IRGs in brain, spleen and kidney, decreased circulating and tissue IFNα levels, decreased microglial activation (IBA-1 expression) and reduced depressive-like behavior. Serotonin levels that are decreased in depression were increased by captopril treatment. Captopril also reduced autoantibody levels in plasma and immune complex deposition in kidney and brain. Thus, ACEi's may have potential for therapeutic use for systemic and NPSLE.
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Affiliation(s)
- Cassandra Nocito
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Cody Lubinsky
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Michelle Hand
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Sabeeya Khan
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Tulsi Patel
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Alecia Seliga
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Malika Winfield
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Viviana Zuluaga-Ramirez
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Nicole Fernandes
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Xiangdang Shi
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Ellen M Unterwald
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Yuri Persidsky
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Uma Sriram
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
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Bhat SA, Goel R, Shukla S, Shukla R, Hanif K. Angiotensin Receptor Blockade by Inhibiting Glial Activation Promotes Hippocampal Neurogenesis Via Activation of Wnt/β-Catenin Signaling in Hypertension. Mol Neurobiol 2017; 55:5282-5298. [DOI: 10.1007/s12035-017-0754-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/23/2017] [Indexed: 12/21/2022]
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Planton M, Raposo N, Danet L, Albucher JF, Péran P, Pariente J. Impact of spontaneous intracerebral hemorrhage on cognitive functioning: An update. Rev Neurol (Paris) 2017; 173:481-489. [PMID: 28838790 DOI: 10.1016/j.neurol.2017.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/26/2017] [Accepted: 06/16/2017] [Indexed: 12/22/2022]
Abstract
Intracerebral hemorrhage (ICH) accounts for 15% of all strokes and approximately 50% of stroke-related mortality and disability worldwide. Patients who have experienced ICH are at high risk of negative outcome, including stroke and cognitive disorders. Vascular cognitive impairment are frequently seen after brain hemorrhage, yet little is known about them, as most studies have focused on neuropsychological outcome in ischemic stroke survivors, using well-documented acute and chronic cognitive scores. However, recent evidence supports the notion that ICH and dementia are closely related and each increases the risk of the other. The location of the lesion also plays a significant role as regards the neuropsychological profile, while the pathophysiology of ICH can indicate a specific pattern of dysfunction. Several cognitive domains may be affected, such as language, memory, executive function, processing speed and gnosis.
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Affiliation(s)
- M Planton
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France.
| | - N Raposo
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - L Danet
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J-F Albucher
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - P Péran
- Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J Pariente
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
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Chitnis AS, Aparasu RR, Chen H, Kunik ME, Schulz PE, Johnson ML. Use of Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Risk of Dementia in Heart Failure. Am J Alzheimers Dis Other Demen 2016; 31:395-404. [PMID: 26705381 PMCID: PMC10852826 DOI: 10.1177/1533317515618799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVE To test the effect of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) on reducing the risk of dementia in patients with heart failure (HF). METHODS This retrospective, longitudinal study used a cohort of HF patients identified from a local Medicare advantage prescription drug plan. Multivariable time-dependent Cox model and marginal structural model using inverse-probability-oftreatment weighting were used to estimate the risk of developing dementia. Adjusted dementia rate ratios were estimated among current and former ACEI/ARB users, as compared with nonusers. RESULTS Using the time-dependent Cox model, the adjusted dementia rate ratios (95% confidence-interval) among current and former users were 0.90(0.70-1.16) and 0.89 (0.71-1.10), respectively. Use of marginal structural model resulted in similar effect estimates for current and former users as compared with the nonusers. CONCLUSION This study found no difference in risk of dementia among the current and former users of ACEI/ARB as compared with the nonusers in an already at-risk HF population.
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Affiliation(s)
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Mark E Kunik
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA; Baylor College of Medicine; VA South Central Mental Illness Research, Education and Clinical Center
| | - Paul E Schulz
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael L Johnson
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
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Abstract
Increasing life expectancy has made old age-related health problems like dementia and cognitive decline more prevalent, and these are rapidly becoming important causes of disability and poor quality of life, causing significant add-ons to health-care costs worldwide. Hypertension is the most important modifiable vascular risk factor for the development and progression of both cognitive decline and dementia. In many observational and randomized studies, antihypertensive therapies have been shown to be beneficial in slowing cognitive decline. However, due to observed discrepancies by these studies, there is a lack of consensus on the best antihypertensive strategy for the prevention or slowing of cognitive decline. It is also not clear whether the beneficial effect of antihypertensive therapy is due to the use of a specific class of agents or combination therapy. Thus, we present a comprehensive review of overall antihypertensive therapies and cognition and of the individual antihypertensive therapy classes with their specific protective mechanisms and available clinical evidence behind their effect on cognitive function.
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Peters J, Booth A, Peters R. Potential for specific dihydropyridine calcium channel blockers to have a positive impact on cognitive function in humans: a systematic review. Ther Adv Chronic Dis 2015; 6:160-9. [PMID: 26137206 PMCID: PMC4480546 DOI: 10.1177/2040622315582353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is some evidence to suggest a possible association between calcium channel blocker (CCB) use and a lower decline in cognitive function compared with use of other hypertensive treatments. In particular, there is an emerging interest in the potential for specific CCBs, particularly the dihydropyridine CCBs nitrendipine, nicardipine, cilnidipine, lercandipine, nimodipine, azelnidipine and nilvadipine. The aim of this review was to assess the evidence relating to these specific CCBs and incident cognitive decline or dementia in humans. METHODS A systematic review of the literature was carried out. The databases MEDLINE, Embase and PsychINFO were searched from 1980 to 18 April 2014. All abstracts were reviewed by two independent reviewers. RESULTS From 753 unique records, 16 full text articles were examined and three retained. The three articles reported data from two studies. A 12-week double-blind randomized controlled trial of nitrendipine compared with cilazapril and a longer and larger double-blind placebo-controlled trial also of nitrendipine, namely the Systolic Hypertension in Europe trial (SYST-EUR). Nitrendipine was associated with a reduction in incident dementia in the SYST-EUR trial. There was no association seen for cognitive outcomes in the smaller trial. CONCLUSION At present there is limited evidence to suggest that nitrendipine may be associated with reduction in incident dementia. This association comes from a single trial and needs to be replicated. Furthermore, there is no high-quality evidence for any of the other potential candidate CCBs.
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Affiliation(s)
- Jean Peters
- School of Health and Related Research (ScHARR). The University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR). The University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - Ruth Peters
- School of Public Health, Imperial College London, St Mary's Campus, London W2 1PG, UK
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Goel R, Bhat SA, Rajasekar N, Hanif K, Nath C, Shukla R. Hypertension exacerbates predisposition to neurodegeneration and memory impairment in the presence of a neuroinflammatory stimulus: Protection by angiotensin converting enzyme inhibition. Pharmacol Biochem Behav 2015; 133:132-45. [PMID: 25869103 DOI: 10.1016/j.pbb.2015.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/17/2015] [Accepted: 04/06/2015] [Indexed: 01/06/2023]
Abstract
Hypertension is a risk factor for cognitive impairment. Furthermore, neuroinflammation and neurodegeneration are intricately associated with memory impairment. Therefore, the present study aimed to explore the involvement of hypertension and angiotensin system in neurodegeneration and memory dysfunction in the presence of neuroinflammatory stimulus. Memory impairment was induced by chronic neuroinflammation that was developed by repeated intracerebroventricular (ICV) injections of lipopolysaccharide (LPS) on the 1st, 4th, 7th, and 10th day. Memory functions were evaluated by the Morris water maze (MWM) test on days 13-15, followed by biochemical and molecular studies in the cortex and hippocampus regions of rat brain. LPS at the dose of 25μg ICV caused memory impairment in spontaneously hypertensive rats (SHRs) but not in normotensive Wistar rats (NWRs). Memory deficit was obtained with 50μg of LPS (ICV) in NWRs. Control SHRs already exhibited increased angiotensin converting enzyme (ACE) activity and expression, neuroinflammation (increased TNF-α, GFAP, COX-2 and NF-kB), oxidative stress (increased iNOS, ROS and nitrite levels), TLR-4 expression and TUNEL positive cells as compared to control NWRs. Further, LPS (25μg ICV) exaggerated inflammatory response, oxidative stress and apoptosis in SHRs but similar effects were witnessed at 50μg of LPS (ICV) in NWRs. Oral administration of perindopril (ACE inhibitor), at non-antihypertensive dose (0.1mg/kg), for 15days attenuated LPS induced deleterious changes in both NWRs and SHRs. Our data suggest that susceptibility of the brain for neurodegeneration and memory impairment induced by neuroinflammation is enhanced in hypertension, and that can be protected by ACE inhibition.
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Affiliation(s)
- Ruby Goel
- Divisions of Pharmacology and Toxicology, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Shahnawaz Ali Bhat
- Divisions of Pharmacology and Toxicology, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - N Rajasekar
- Divisions of Pharmacology and Toxicology, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), India
| | - Kashif Hanif
- Divisions of Pharmacology and Toxicology, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), India
| | - Chandishwar Nath
- Divisions of Pharmacology and Toxicology, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), India
| | - Rakesh Shukla
- Divisions of Pharmacology and Toxicology, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), India.
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Kovács KR, Bajkó Z, Szekeres CC, Csapó K, Oláh L, Magyar MT, Molnár S, Czuriga D, Kardos L, Burainé AB, Bereczki D, Soltész P, Csiba L. Elevated LDL-C combined with hypertension worsens subclinical vascular impairment and cognitive function. ACTA ACUST UNITED AC 2014; 8:550-60. [PMID: 25151317 DOI: 10.1016/j.jash.2014.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
Hypertension and dyslipidemia belong to the most prevalent modifiable risk factors for cerebrovascular and cardiovascular diseases. Hereby, we aimed to examine the combined effects of newly diagnosed hypertension and hyperlipidemia on the characteristics of the arterial wall and on cognitive function. We examined 72 hypertensive and 85 apparently healthy individuals. Based on serum lipid levels, four subgroups were created ranging from normotensive-normolipidemic to hypertensive-hyperlipidemic subjects. Carotid intima-media thickness (IMT), arterial stiffness, and cognitive function were assessed. IMT of controls was the lowest, whereas that of patients with both risk factors the highest. Stiffness parameters increased when both risk factors were present, whereas subjects with only one risk factor exhibited intermediate values. Hypertensive patients performed worse when memory, attention, reaction time, and trait anxiety were assessed. Significant worsening of IMT, arterial stiffness, and sum of neuropsychological scores was observed along with increasing mean arterial pressure. Generally, hyperlipidemia combining with hypertension resulted in further worsening of all examined parameters. Subclinical changes of the vascular wall and cognitive performance are already present in recently diagnosed hypertensive patients. Combination of hyperlipidemia and hypertension results in more severe impairments, therefore, early and intensive treatment may be crucial to prevent further deterioration.
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Affiliation(s)
- Katalin Réka Kovács
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary.
| | - Zoltán Bajkó
- Department of Neurology, Mureş County Clinical Emergency Hospital, Târgu-Mureş, Romania
| | | | - Krisztina Csapó
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Oláh
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Mária Tünde Magyar
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Sándor Molnár
- Department of Neurology, Elisabeth Teaching Hospital of Sopron, Sopron, Hungary
| | - Dániel Czuriga
- Institute of Cardiology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Kardos
- Contract Medical Statistician, Kenézy Gyula Hospital, Debrecen, Hungary
| | | | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Pál Soltész
- Department of Angiology, Medical Faculty Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
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Romero JP, Benito-León J, Bermejo-Pareja F. The NEDICES Study: Recent Advances in the Understanding of the Epidemiology of Essential Tremor. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-70-346-2. [PMID: 23439396 PMCID: PMC3570054 DOI: 10.7916/d8n58k4h] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 11/10/2011] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Essential tremor (ET) is the most common tremor disorder. ET has classically been viewed as a benign monosymptomatic condition. Yet over the past 10 years, a growing body of evidence indicates that this is a progressive condition that is clinically heterogeneous, and may be associated with a variety of different features. Large epidemiological studies such as the Neurological Disorders of Central Spain (NEDICES), a longitudinal, population-based survey, have contributed significantly to the changing view of the disease. Our aim is to review some of the main results of NEDICES within the larger framework of the epidemiology of ET. METHODS Data for this review were gathered from all our articles published up to October 2011 regarding NEDICES study and "Essential Tremor". RESULTS We have published 18 articles up to October 2011. The prevalence, incidence, and mortality of ET were analyzed in this cohort. In addition, ET was found to be associated with increased frailty and low morale, as well as with a series of non-motor manifestations, including cognitive deficits, mild cognitive impairment, dementia, depressive symptoms, and hearing impairment. Finally, the link between ET and Parkinson's disease (PD) was formally quantified in the NEDICES study, which demonstrated that the risk of developing incident PD was 4.3 times higher in prevalent ET cases than in age-matched controls without ET. CONCLUSIONS This review highlights the contributions of NEDICES towards the advancement of current knowledge of the epidemiology and clinical features of ET, and emphasizes the importance of population-based studies towards the understanding of complex, ageing-related diseases.
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Affiliation(s)
- Juan Pablo Romero
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Félix Bermejo-Pareja
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
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Johnson ML, Parikh N, Kunik ME, Schulz PE, Patel JG, Chen H, Aparasu RR, Morgan RO. Antihypertensive drug use and the risk of dementia in patients with diabetes mellitus. Alzheimers Dement 2012; 8:437-44. [DOI: 10.1016/j.jalz.2011.05.2414] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 04/20/2011] [Accepted: 05/20/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Michael L. Johnson
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
- Houston Center for Quality of Care & Utilization Studies; Veterans Affairs Medical Center; Houston TX USA
| | - Niraj Parikh
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Mark E. Kunik
- Houston Center for Quality of Care & Utilization Studies; Veterans Affairs Medical Center; Houston TX USA
- Menninger Department of Psychiatry and Behavioral Sciences; Baylor College of Medicine; Houston TX USA
- Veterans Affairs South Central Mental Illness Research; Education and Clinical Center; Houston TX USA
| | - Paul E. Schulz
- Department of Neurology; The Mischer Neuroscience Institute at The University of Texas Health Science Center; Memorial Hermann Hospital; Houston TX USA
| | - Jeetvan G. Patel
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Hua Chen
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Rajender R. Aparasu
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Robert O. Morgan
- Houston Center for Quality of Care & Utilization Studies; Veterans Affairs Medical Center; Houston TX USA
- School of Public Health; Division of Management; Policy and Community Health at The University of Texas Health Science Center; Houston TX USA
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Sakurai-Yamashita Y, Harada N, Niwa M. Lercanidipine Rescues Hippocampus Pyramidal Neurons from Mild Ischemia-Induced Delayed Neuronal Death in SHRSP. Cell Mol Neurobiol 2011; 31:561-7. [DOI: 10.1007/s10571-011-9649-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/05/2011] [Indexed: 12/01/2022]
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Sánchez F, Gómez-Villalobos MDJ, Juarez I, Quevedo L, Flores G. Dendritic morphology of neurons in medial prefrontal cortex, hippocampus, and nucleus accumbens in adult SH rats. Synapse 2010; 65:198-206. [DOI: 10.1002/syn.20837] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Cumulative evidence implicates hypertension in the pathogenesis of Alzheimer disease. Although it may not presently be possible to completely differentiate the effects of treatment and control of hypertension itself from those of the medication used to achieve such treatment goals, efforts directed at the treatment and control of hypertension can have significant public health impact.
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Affiliation(s)
- Thomas Olabode Obisesan
- Division of Geriatrics, Department of Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
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Tayebati S, Di Tullio M, Amenta F. Vesicular Acetylcholine Transporter (VAChT) in the Brain of Spontaneously Hypertensive Rats (SHR): Effect of Treatment with an Acetylcholinesterase Inhibitor. Clin Exp Hypertens 2009; 30:732-43. [DOI: 10.1080/10641960802580216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gupta R, Solanki RK, Pathak V. Blood pressure is associated with cognitive impairment in young hypertensives. World J Biol Psychiatry 2008; 9:43-50. [PMID: 17853255 DOI: 10.1080/15622970601187784] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS The present study was conducted to assess the effects of duration of hypertension, systolic hypertension, diastolic hypertension, drug compliance and class-of-drug on cognitive functions. METHODS AND RESULTS A cohort of young hypertensive subjects was recruited after obtaining informed consent. Subjects with confounding factors, e.g., substance use, neurological disorders, endocrinopathies, inflammatory conditions, psychiatric illnesses, etc., were excluded. Their average systolic and diastolic blood pressure since onset of illness and prescribed drugs were noted from the records. Compliance was assessed with the help of information from subjects as well as the close relatives. MMSE and a battery of neuropsychological tests (Digit Span Test, Trail Making Test Form B, Stroop Test, Visuospatial Working Memory Matrix and Word Fluency Test) was applied to all the participants. Multivariate regression analysis was used for the assessment of associations and one-way ANOVA was performed to assess differences in the mean. Analysis showed that mean age of study subject was 52 years and average duration of hypertension was 9 years. Fourteen percent subjects had obvious cognitive impairment as suggested by MMSE score less than 23. However, when cut-off score was lowered to 20, only 6% subjects fell into this category. Diastolic blood pressure had significant negative association with all of the cognitive measures except Trail Making Test, which was, on the contrary, significantly and negatively associated with systolic blood pressure. Duration of hypertension did not influence cognitive performance in this study. Effect of drug compliance was somewhat variable, but in general good compliance was associated with better cognitive performance. Beta-Blocker therapy hampered cognitive performance, whereas the best performance, especially on tests of semantic memory and pre-frontal functions was seen in subjects taking calcium channel blockers. CONCLUSIONS Diastolic hypertension was associated with significant impairment of cognitive functions in younger subjects. On the other hand good compliance and calcium channel blockers had protective effect on hypertension induced cognitive impairment, especially on the prefrontal functions.
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Affiliation(s)
- Ravi Gupta
- Department of Psychiatry, S.M.S. Medical College, Jaipur, India.
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Obisesan TO, Obisesan OA, Martins S, Alamgir L, Bond V, Maxwell C, Gillum RF. High blood pressure, hypertension, and high pulse pressure are associated with poorer cognitive function in persons aged 60 and older: the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc 2008; 56:501-9. [PMID: 18179496 DOI: 10.1111/j.1532-5415.2007.01592.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To test the hypothesis that hypertension, high blood pressure, and high pulse pressure (PP) are independently associated with lower cognitive function. DESIGN Cross-sectional study of persons examined in 1988 to 1994. SETTING U.S. noninstitutionalized population. PARTICIPANTS Six thousand one hundred sixty-three men and women aged 60 and older who participated in the Third National Health and Nutrition Examination Survey (NHANES III). MEASUREMENTS Measurements included blood pressure, short-portable Mini-Mental State Examination (sp-MMSE), self-reported history of hypertension, diagnosis, and treatment. RESULTS In the initial bivariate analysis within age groups of 60 to 64, 65 to 69, and 70 to 74, optimal blood pressure (< 120/80 mmHg) was associated with best cognitive performance; the severe hypertension group had the poorest performance in all age groups except the very old (> or = 80), where the pattern was reversed, showing poorest performance in the optimal blood pressure group and best in the group with moderate hypertension. This pattern changed slightly in multiple regression analyses modeling sp-MMSE as the outcome variable. Higher stage of hypertension according to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and higher PP were associated with worse cognitive performance than normal blood pressure at ages 70 to 79 and 80 and older. No significant negative association was seen in subjects aged 60 to 69. Subjects with treated but uncontrolled hypertension had significantly lower sp-MMSE scores than those without hypertension or with controlled hypertension after controlling for age, sex, ethnicity, income, and PP. CONCLUSION At age 70 and older, high blood pressure, hypertension, and uncontrolled blood pressure are associated with poorer cognitive function than normal blood pressure. Optimal control of blood pressure may be useful in preserving neurocognitive loss as the population ages.
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Affiliation(s)
- Thomas Olabode Obisesan
- Department of Medicine, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave, NW, Washington, DC 20060, USA.
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Abstract
Diabetes is a major public health burden. Even a modest effect of diabetes on cognitive function has significant public health implications. Several lines of mechanistic evidence implicate a role of insulin and glucose metabolism on risk of developing dementia, including Alzheimer's disease. Population-based studies have shown that those with type 2 diabetes mellitus have an increased risk of cognitive impairment, dementia, and neurodegeneration. There are many mechanisms through which diabetes could increase risk of dementia, including glycemia, insulin resistance, oxidative stress, advanced glycation endproducts, inflammatory cytokines, and microvascular and macrovascular disease. This paper presents a review of the evidence on diabetes and increased risk of dementia and cognitive impairment, a discussion of different possible mechanisms, and remaining gaps in our knowledge.
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Affiliation(s)
- Rachel A Whitmer
- Kaiser Permanente Division of Research, Epidemiology Etiology & Prevention, 2000 Broadway, Oakland, CA 94612, USA.
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Lanari A, Silvestrelli G, De Dominicis P, Tomassoni D, Amenta F, Parnetti L. Arterial hypertension and cognitive dysfunction in physiologic and pathologic aging of the brain. ACTA ACUST UNITED AC 2007; 16:158-64. [PMID: 17483667 DOI: 10.1111/j.1076-7460.2007.06502.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arterial hypertension is the most important modifiable cerebrovascular risk factor; its relationship with cerebrovascular disease is continuous, consistent, and independent. Different and probably converging pathophysiologic mechanisms explain the role of arterial hypertension in causing cognitive dysfunction in pathologic aging of the brain, specifically, vascular dementia and Alzheimer's disease.
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Affiliation(s)
- Alessia Lanari
- Section of Neurology, University of Perugia, Perugia, Italy
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Cohuet G, Struijker-Boudier H. Mechanisms of target organ damage caused by hypertension: therapeutic potential. Pharmacol Ther 2005; 111:81-98. [PMID: 16288809 DOI: 10.1016/j.pharmthera.2005.09.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 09/14/2005] [Indexed: 12/24/2022]
Abstract
Hypertension is a major risk factor for cardiovascular mortality and morbidity through its effects on target organs like the brain, heart, and kidney. Structural alterations in the microcirculation form a major link between hypertension and target organ damage. In this review, we describe damages related to hypertension in these target organs and the mechanisms involved in the pathogenesis of hypertension-induced cardiovascular diseases such as dementia, cardiac ischemia and remodeling, or nephropathy. We also focus on the therapeutical potential on the basis of such mechanisms. Several antihypertensive agents like diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II (Ang II) receptor antagonists, beta-blockers, or calcium channel blockers (CCBs) have been shown to reduce effectively hypertension associated cardiovascular events and to improve end organ damage. More recently, aldosterone antagonism has also shown beneficial effects. Part of the favorable effects of these agents is due to blood pressure lowering as such. Other mechanisms such as oxidative stress, inflammation, or endothelial dysfunction have appeared to play a key role in the pathogenesis of target organ damage and therefore represent another important pathway for therapy. In this review, we discuss the different therapeutic approaches aiming at reducing cardiovascular events and damages induced by hypertension.
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Affiliation(s)
- G Cohuet
- Cardiovascular Research Institute of Maastricht, Pharmacology and Toxicology, Universiteitssingel 50, PO BOX 616, 6200 MD Maastricht, The Netherlands
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Shang Y, Cheng J, Qi J, Miao H. Scutellaria flavonoid reduced memory dysfunction and neuronal injury caused by permanent global ischemia in rats. Pharmacol Biochem Behav 2005; 82:67-73. [PMID: 16129477 DOI: 10.1016/j.pbb.2005.06.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 06/01/2005] [Accepted: 06/24/2005] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to investigate the effects of flavonoid, isolated from aerial parts of Scutellaria baicalensis Georgi (SSF), on memory deficits, neuronal degeneration and abnormal energy metabolism induced by permanent global ischemia in rats. The global ischemia was produced in female Sprague-Dawley rats by permanent occlusion of the bilateral common carotid arteries. The permanent global ischemia in rats resulted in a significantly increased latency of the rat to find the hidden platform and a decreased swimming distance from the target quadrant in the Morris water maze task. The pathological changes in the neurons of ischemic rats, observed in the hippocampus and cerebral cortex, included neuron loss, neuron swelling, nuclear shrinkage or disappearance, neuronophagia and reduced density of Nissl bodies in the neuron. Moreover, the levels of lactate and ATPase activity in ischemic rats were notably increased and decreased, respectively, in the hippocampus and cerebral cortex as compared with sham-operated rats. Daily oral administration of SSF (35 mg/kg, 19-20 days) dramatically reduced the decrease in learning and memory, attenuated neuronal injury and improved abnormality of energy metabolites in rats induced by global ischemia. These findings suggest that SSF may be beneficial for the treatment of vascular dementia.
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Affiliation(s)
- Yazhen Shang
- Institute of Chinese Materia Medica, Chengde Medical College, Chengde, 067000, PR China.
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Vega E, Gómez-Villalobos MDJ, Flores G. Alteration in dendritic morphology of pyramidal neurons from the prefrontal cortex of rats with renovascular hypertension. Brain Res 2004; 1021:112-8. [PMID: 15328038 DOI: 10.1016/j.brainres.2004.06.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2004] [Indexed: 10/26/2022]
Abstract
We have studied, in the rat, the dendritic morphological changes of the pyramidal neurons of the medial part of the prefrontal cortex induced by the chronic effect of high blood pressure. Renovascular hypertension was induced using a silver clip on the renal artery by surgery. The morphology of the pyramidal neurons from the medial part of the prefrontal cortex was investigated in these animals. The blood pressure was measured to confirm the increase in the arterial blood pressure. After 16 weeks of increase in the arterial blood pressure, the animals were sacrificed by overdoses of sodium pentobarbital and perfused intracardially with a 0.9% saline solution. The brains were removed, processed by the Golgi-Cox stain method and analyzed by the Sholl method. The dendritic morphology clearly showed that the hypertensive animals had an increase (32%) in the dendritic length of the pyramidal cells with a decrease (50%) in the density of dendritic spines when compared with sham animals. The branch-order analysis showed that the animals with hypertension exhibit more dendritic arborization at the level of the first to fourth branch order. This result suggests that renovascular hypertension may in part affect the dendritic morphology in this limbic structure, which may implicate cognitive impairment in hypertensive patients.
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Affiliation(s)
- Elenia Vega
- Escuela de Biología, Universidad Autónoma de Puebla, Puebla, México
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Paglieri C, Bisbocci D, Di Tullio MA, Tomassoni D, Amenta F, Veglio F. Arterial Hypertension: A Cause of Cognitive Impairment and of Vascular Dementia. Clin Exp Hypertens 2004; 26:277-85. [PMID: 15195684 DOI: 10.1081/ceh-120034134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Arterial hypertension is a well-documented modifiable risk factor for cerebrovascular disease and for both cerebral infarction and intracerebral hemorrhage. Recent studies indicate a relationship between high blood pressure in midlife and dementia in late life and suggest that arterial hypertension may represent a cause of vascular dementia (VaD). This paper has reviewed the main evidence of a link between arterial hypertension and vascular cognitive impairment or VaD. Brain lesions induced by hypertension, diagnostic procedures for early diagnosis of vascular cognitive impairment in at risk subjects and the need to include cognitive assessment in patient's general visits in hypertension units are discussed.
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Affiliation(s)
- Cristina Paglieri
- Centro di Ipertensione Arteriosa, Ospedale San Vito, Università di Torino, Torino, Italy
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Abstract
PURPOSE OF REVIEW We present an updated overview on the long-term effects of hypertension on the occurrence of cognitive dysfunction and overt degenerative or vascular dementia later in life. The preventative effects of antihypertensive treatment in this regard are examined, with a focus on placebo-controlled, double-blind, randomized prospective trials. RECENT FINDINGS The stereotypical straightforward linear relationship between mid-life hypertension and dementia later in life can no longer be considered strictly invariable. Successfully treated hypertensive patients who are still at risk for clinical dementia late in life may ultimately fare better in the presence of a slightly elevated rather than low systolic blood pressure. The mechanisms underlying this 'J-curve' phenomenon are currently being explored. Recently completed prospective randomized antihypertensive trials (Syst-Eur 2, PROGRESS and SCOPE) have yielded variable results, and merit cautious interpretation. SUMMARY The incidence and prevalence of dementia are increasing exponentially worldwide, particularly in those older than 70 years. Because hypertension predisposes to dementia, therapeutic blood pressure titration should be maintained over the years, and intensified beyond 70 years in order to avoid over-treatment in the latter period.
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