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Avan A, Nucera A, Stranges S, Rocca WA, Logroscino G, Leonardi M, Raggi A, Hachinski V. Risk and sex-specific trends of dementia and stroke in Italy Compared to European and high-income countries and the world: global implications. J Neurol 2024; 271:2745-2757. [PMID: 38388926 DOI: 10.1007/s00415-024-12216-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/20/2023] [Accepted: 01/20/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Understanding the increasing trends in Italy may inform new prevention strategies and better treatments. We investigated trends and risk factors of dementia, stroke, and ischemic heart disease (IHD) in Italy with the second-oldest population globally, compared to European and high-income countries and the world. METHODS We analyzed the Global Burden of Disease Study (GBD) 2019 estimates on incidence and burden (i.e., disability and death combined) of the three conditions in both sexes. We also analyzed the burden attributable to 12 modifiable risk factors and their changes during 1990-2019. RESULTS In 2019, Italy had 186,108 new dementias (123,885 women) and 94,074 new strokes (53,572 women). Women had 98% higher crude dementia and 24% higher crude stroke burdens than men. The average age-standardized new dementia rate was 114.7 per 100,000 women and 88.4 per 100,000 men, both higher than Western Europe, the European Union, high-income countries, and the world. During 1990-2019, this rate increased in both sexes (4%), despite a decline in stroke (- 45%) and IHD (- 17%) in Italy. Dementia burden attributable to tobacco decreased in both sexes (- 12.7%) during 1990-2019, while high blood glucose and high body mass index combined burden increased (25.4%). Stroke and IHD had similar trends. CONCLUSIONS While decreases in new strokes and IHDs are encouraging, new approaches to their joint prevention are required to reverse the rising dementia trends, especially among women. Life course approaches to promoting holistic brain health should be implemented at the community, national, and international levels before the growing trends become overwhelming.
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Affiliation(s)
- Abolfazl Avan
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - Antonia Nucera
- Neurovascular Treatment Unit, Spaziani Hospital, Frosinone, Italy
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
- Department of Family Medicine and Medicine, University of Western Ontario, London, Canada
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
- The Africa Institute, University of Western Ontario, London, Canada
| | - Walter A Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases, Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Matilde Leonardi
- Department of Neurology, Public Health, and Disability, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto Raggi
- Department of Neurology, Public Health, and Disability, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vladimir Hachinski
- Robarts Research Institute, University of Western Ontario, London, ON, Canada.
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada.
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
- Department of Clinical Neurological Sciences, Robarts Research Institute, University of Western Ontario, 1151 Richmond St. N., London, ON, N6A 5B7, Canada.
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Singh SD, Senff JR, van Duijn CM, Rosand J. Treating Hypertension: Important for Heart Health, Fundamental for Brain Health. Stroke 2024; 55:1464-1466. [PMID: 38488382 PMCID: PMC11039372 DOI: 10.1161/strokeaha.123.046179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2024]
Abstract
The Brain Health crisis stands as one of humankind's most pressing threats, with age-related noncommunicable brain diseases, particularly stroke, and dementia, affecting hundreds of millions annually and jeopardizing the economic well-being of populations worldwide. Epidemiological studies indicate that ≈40% of dementia and 60% of stroke cases are attributable to modifiable risk factors. In this Comments and Opinions article, we underscore the pivotal role of blood pressure (BP) control in reducing suffering, enhancing economic well-being, and promoting healthy longevity for populations worldwide. Emphasizing that BP control is crucial for both brain and heart health, it advocates for heightened awareness, positioning hypertension as a primary focus for preventing dementia and stroke with potential global impact. Despite its significance, BP control encounters global challenges, with proportions of the population maintaining adequately controlled hypertension ranging from 23% to 90%. The World Health Organization estimated that 46% of the 1.28 billion people with hypertension are unaware of their elevated BP. Given the notable disparities in BP management, addressing BP management also contributes to combating significant health inequalities. The next time you are faced with a patient anxious about the prospect of experiencing a fate similar to a parent with dementia or a sister with a stroke, we suggest a straightforward answer for health care providers: start ensuring BP control. BP is a matter of brain health, and it is a matter of our economic future.
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Affiliation(s)
- Sanjula D. Singh
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jasper R. Senff
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Faraci FM, Scheer FA. Hypertension: Causes and Consequences of Circadian Rhythms in Blood Pressure. Circ Res 2024; 134:810-832. [PMID: 38484034 PMCID: PMC10947115 DOI: 10.1161/circresaha.124.323515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Hypertension is extremely common, affecting approximately 1 in every 2 adults globally. Chronic hypertension is the leading modifiable risk factor for cardiovascular disease and premature mortality worldwide. Despite considerable efforts to define mechanisms that underlie hypertension, a potentially major component of the disease, the role of circadian biology has been relatively overlooked in both preclinical models and humans. Although the presence of daily and circadian patterns has been observed from the level of the genome to the whole organism, the functional and structural impact of biological rhythms, including mechanisms such as circadian misalignment, remains relatively poorly defined. Here, we review the impact of daily rhythms and circadian systems in regulating blood pressure and the onset, progression, and consequences of hypertension. There is an emphasis on the impact of circadian biology in relation to vascular disease and end-organ effects that, individually or in combination, contribute to complex phenotypes such as cognitive decline and the loss of cardiac and brain health. Despite effective treatment options for some individuals, control of blood pressure remains inadequate in a substantial portion of the hypertensive population. Greater insight into circadian biology may form a foundation for novel and more widely effective molecular therapies or interventions to help in the prevention, treatment, and management of hypertension and its related pathophysiology.
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Affiliation(s)
- Frank M. Faraci
- Department of Internal Medicine, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
- Department of Neuroscience and Pharmacology, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
| | - Frank A.J.L. Scheer
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, 02115
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, 02115
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Algahtani H, Shirah B, Hachinski V. Primordial and Primary Prevention of Ischemic Stroke in Saudi Arabia: A Combination Approach and Evolving Concepts. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:1-9. [PMID: 38362089 PMCID: PMC10866385 DOI: 10.4103/sjmms.sjmms_62_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/18/2023] [Accepted: 09/20/2023] [Indexed: 02/17/2024]
Abstract
Ischemic stroke is a considerable public health hazard and a significant cause of disability and mortality in Saudi Arabia. Primary prevention strategies in the country are currently limited. With the health sector transformation program that depends on the principles of value-based care and applying the new model of care in disease prevention, aggressive and serious steps for primary stroke prevention are expected to be implemented. This article reviews primordial and primary prevention of ischemic stroke in Saudi Arabia and suggests a combination approach and framework for implementation. We provide a pragmatic solution to implement primordial and primary stroke prevention in Saudi Arabia and specify the roles of the government, health professionals, policymakers, and the entire population. Currently, there are several key priorities for primordial and primary stroke prevention in Saudi Arabia that should target people at different levels of risk. These include an emphasis on a comprehensive approach that includes both individual and population-based strategies and establishing partnerships across health-care providers to share responsibility for developing and implementing both strategies. This is an urgent call for action to initiate different strategies suggested by experts for primary stroke prevention in Saudi Arabia.
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Affiliation(s)
| | - Bader Shirah
- Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Robarts Research Institute, Western University, London, Ontario, Canada
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Kota KJ, Dawson A, Papas J, Sotelo V, Su G, Li M, Lee W, Estervil J, Marquez M, Sarkar S, Lopez LL, Hu WT. Factors associated with attitudes toward research MRI in older Asian Americans. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12449. [PMID: 38356478 PMCID: PMC10865479 DOI: 10.1002/trc2.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION South Asian (SA) and East Asian (EA) older adults represent the fastest-growing racial/ethnic groups of Americans at risk for dementia. While recruiting older SA adults into a brain health study, we encountered unexpected hesitancy toward structural brain magnetic resonance imaging (MRI) analysis and stigmatizing attitudes related to internal locus of control (LoC) for future dementia risks. We hypothesized that support for MRI-related research was influenced by these attitudes as well as personal MRI experience, perceived MRI safety, and concerns for personal risk for future dementia/stroke. METHODS We developed a brief cross-sectional survey to assess older adults' MRI experiences and perceptions, desire to learn of six incidental findings of increasing impact on health, and attitudes related to dementia (including LoC) and research participation. We recruited a convenience sample of 256 respondents (74% reporting as 50+) from the New Jersey/New York City area to complete the survey (offered in English, Chinese, Korean, and Spanish) and modeled the proportional odds (PO) for favorable attitudes toward research activities. RESULTS Seventy-seven SA and 84 EA respondents were analyzed alongside 95 White, Black, or Hispanic adults. White (PO = 2.54, p = 0.013) and EA (PO = 2.14, p = 0.019) respondents were both more likely than SA respondents to endorse healthy volunteers' participation in research, and the difference between White and SA respondents was mediated by the latter's greater internal LoC for dementia risks. EA respondents had more worries for future dementia/stroke than SA respondents (p = 0.006) but still shared SA respondents' lower wish (measured by proportion of total) to learn of incidental MRI findings. DISCUSSION SA-and EA compared to SA-older adults had low desire to learn of incidental MRI findings but had different attitudes toward future dementia/stroke risks. A culturally appropriate protocol to disclose incidental MRI findings may improve SA and EA participation in brain health research. Highlights Older Asian Americans have limited interest in incidental findings on research MRISouth Asians are most likely to attribute dementia to people's own behaviorsSouth Asians' attitudes mediate lower support for healthy volunteers in researchSouth and East Asians differ in dementia worries and research-related attitudes.
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Affiliation(s)
- Karthik J Kota
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Departments of MedicineRutgers‐Robert Wood Johnson Medical SchoolInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Alice Dawson
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Julia Papas
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Victor Sotelo
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Guibin Su
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Mei‐Ling Li
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Woowon Lee
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Jaunis Estervil
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Melissa Marquez
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Shromona Sarkar
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Lisa Lanza Lopez
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - William T. Hu
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
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Singh SD, Oreskovic T, Carr S, Papier K, Conroy M, Senff JR, Chemali Z, Gutierrez-Martinez L, Parodi L, Mayerhofer E, Marini S, Nunley C, Newhouse A, Ouyang A, Brouwers HB, Westover B, Rivier C, Falcone G, Howard V, Howard G, Pikula A, Ibrahim S, Sheth KN, Yechoor N, Lazar RM, Anderson CD, Tanzi RE, Fricchione G, Littlejohns T, Rosand J. The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort. Front Neurol 2023; 14:1291020. [PMID: 38107629 PMCID: PMC10725202 DOI: 10.3389/fneur.2023.1291020] [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: 09/08/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke. Methods The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40-69 years, recruited between 2006-2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline. Results The BCS (median: 12; IQR:11-14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50-59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50-59, and 33% (95%CI, 29-37%) among those aged >59. Discussion The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide.
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Affiliation(s)
- Sanjula D. Singh
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Tin Oreskovic
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Keren Papier
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Megan Conroy
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jasper R. Senff
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Zeina Chemali
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Leidys Gutierrez-Martinez
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Livia Parodi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ernst Mayerhofer
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Sandro Marini
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Courtney Nunley
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Amy Newhouse
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - An Ouyang
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - H. Bart Brouwers
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Brandon Westover
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Cyprien Rivier
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Guido Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Virginia Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Aleksandra Pikula
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sarah Ibrahim
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Nirupama Yechoor
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ronald M. Lazar
- McKnight Brain Institute, Department of Neurology, School of Medicine, University of Alabama School of Medicine, Birmingham, AL, United States
| | - Christopher D. Anderson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Rudolph E. Tanzi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Gregory Fricchione
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Thomas Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
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Hachinski V. Prevention of dementia with holistic brain health. Lancet Neurol 2023; 22:1101. [PMID: 37977702 DOI: 10.1016/s1474-4422(23)00418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON N6A 5A5, Canada.
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Imahori Y, Vetrano DL, Ljungman P, Laukka EJ, Wu J, Grande G, Rizzuto D, Fratiglioni L, Qiu C. Association of ischemic heart disease with long-term risk of cognitive decline and dementia: A cohort study. Alzheimers Dement 2023; 19:5541-5549. [PMID: 37249150 DOI: 10.1002/alz.13114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The independent and joint effect of ischemic heart disease (IHD) and coexisting atrial fibrillation (AF) and heart failure (HF) on dementia risk is largely unknown. METHODS This population-based cohort study included 2568 dementia-free participants (age ≥60 years) in SNAC-K, who were regularly examined from 2001-2004 through 2013-2016. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Global cognitive function was assessed using a global cognitive composite z-score derived from five cognitive domains. Data were analyzed using Cox, Fine-Gray, and linear mixed-effects models. RESULTS Overall, IHD at baseline was associated with multivariable-adjusted hazard ratio (HR) of 1.39 (95% confidence interval = 1.06-1.82) for dementia and multivariable-adjusted β-coefficient of -0.02 (-0.03 to -0.01) for annual changes in global cognitive z-score, independent of AF, HF, and cerebrovascular disease. Coexisting AF or HF did not add further risk to dementia and cognitive decline. DISCUSSION IHD is independently associated with dementia and cognitive decline in older adults, whereas coexisting AF/HF is not associated with an increased risk. HIGHLIGHTS Is a history of ischemic heart disease (IHD) associated with a risk for dementia? How do coexisting heart diseases affect this association? IHD was an independent risk factor for dementia in older adults. This association was independent of coexisting heart and cerebrovascular diseases. The coexistence of heart diseases did not confer additional risk for dementia.
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Affiliation(s)
- Yume Imahori
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Davide L Vetrano
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Erika J Laukka
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Jing Wu
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Giulia Grande
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Chengxuan Qiu
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden
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Mao M, Liu R, Dong Y, Wang C, Ren Y, Tian N, Tang S, Hou T, Cong L, Wang Y, Du Y, Qiu C. Resting heart rate, cognitive function, and inflammation in older adults: a population-based study. Aging Clin Exp Res 2023; 35:2821-2829. [PMID: 37898962 PMCID: PMC10628022 DOI: 10.1007/s40520-023-02576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Emerging evidence has linked elevated resting heart rate (RHR) with poor cognitive function in older adults, but the mechanisms underlying their association are poorly understood. METHODS This population-based cross-sectional study included 4510 dementia-free participants (age ≥ 65 years; 56.9% females; 38.3% no formal education) in the baseline examination of the Multidomain Interventions to Delay Dementia and Disability in Rural China study. Of these, 1,386 had data on serum proinflammatory cytokines and adhesion molecules. RHR was measured using 12-lead electrocardiograph. We used the Mini-Mental State Examination (MMSE) and a neuropsychological test battery to assess cognitive function. Data were analyzed using the general linear and restricted cubic splines models. RESULTS People with high RHR were more likely to have cardiometabolic diseases and worse cognitive function (p < 0.05). There was an inverted J-shaped association of RHR with MMSE and attention scores. Having RHR ≥ 80 bpm (vs. 60-69 bpm) was significantly associated with the multivariable-adjusted β coefficients of - 0.58 [95% confidence interval (CI), - 1.00, - 0.16] for MMSE score and - 0.08 (- 0.15, - 0.01) for attention score. In the serum biomarker subsample, RHR was linearly associated with serum interleukin-6 (IL-6) (β coefficient = 0.19; 95%CI 0.14, 0.24), IL-8 (0.08; 0.02, 0.13), IL-10 (0.09; 0.04, 0.15), tumor necrosis factor-α (0.06; 0.01, 0.11), monocyte chemotactic protein-1 (0.09; 0.04, 0.15), intercellular adhesion molecule-1 (0.16; 0.11, 0.22), and vascular cell adhesion molecule-1 (0.11; 0.06, 0.16). CONCLUSIONS There is an inverted J-shaped association of RHR with attention and global cognition. Poor cognitive function and high RHR may be linked through systemic low-grade inflammation and endothelial injury.
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Affiliation(s)
- Ming Mao
- Department of Neurology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Rui Liu
- Department of Neurology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Yi Dong
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, Shandong, People's Republic of China
| | - Chaoqun Wang
- Department of Neurology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Yifei Ren
- Department of Neurology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Na Tian
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, Shandong, People's Republic of China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, Shandong, People's Republic of China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, Shandong, People's Republic of China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, Shandong, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, Shandong, People's Republic of China.
- Institute of Brain Science and Brain-Inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging in Shandong First Medical University, Ministry of Education of the People's Republic of China, Jinan, Shandong, People's Republic of China.
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.
| | - Yifeng Du
- Department of Neurology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, People's Republic of China.
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, Shandong, People's Republic of China.
| | - Chengxuan Qiu
- Department of Neurology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, People's Republic of China
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
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10
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Hachinski V. Poets as Guides in Medicine, Research, and Life. Neurology 2023; 101:721-722. [PMID: 37491323 PMCID: PMC10585671 DOI: 10.1212/wnl.0000000000207582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/10/2023] [Indexed: 07/27/2023] Open
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11
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Hachinski V, Krishnamoorthy E, Kuey L, Kirmayer LJ. Brain health and mental health: Common vascular risk factors and practical implications. Alzheimers Dement 2023; 19:4248-4251. [PMID: 37216631 DOI: 10.1002/alz.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
The pandemic dramatized the close links among cognitive, mental, and social health; a change in one reflects others. This realization offers the opportunity to bridge the artificial separation of brain and mental health, as brain disorders have behavioral consequences and behavioral disorders affect the brain. The leading causes of mortality and disability, namely stroke, heart disease, and dementia, share the same risk and protective factors. It is emerging that bipolar disorders, obsessive compulsive disorders, and some depressions share these risk factors, allowing their joint prevention through a holistic life span approach. We need to learn to focus on the whole patient, not simply on a dysfunctional organ or behavior to mitigate or prevent the major neurological and mental disorders by fostering an integrated approach to brain and mental health and addressing the common, treatable risk factors.
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Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, University of Western Ontario, Robarts Research Institute, London, Ontario, Canada
| | | | - Levent Kuey
- İstanbul Bilgi University Psychology Department, Istanbul, Turkey
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University and Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
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12
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Singh SS, Zhong S, Rogers KA, Hachinski VC, Frisbee SJ. Prevalence of dementia, heart disease and stroke in community-dwelling adults in Canada, 2016-2021: opportunities for joint prevention. Arch Public Health 2023; 81:158. [PMID: 37620877 PMCID: PMC10464200 DOI: 10.1186/s13690-023-01171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION This aim of this study is to provide updated estimates on the prevalence of dementia, heart disease, and stroke in Canadian communities. Targeting all three conditions together, at the community level, may be key to disease prevention and health aging in the Canadian population. METHODS Using nationwide health survey data, we calculated the age-standardized prevalence of self-reported dementia, heart disease and stroke in adults aged 18 years and over residing in Canadian communities from 2016 to 2021. Poisson regression models were used to detect statistically significant changes in the prevalence of all three conditions from 2016 to 2021. RESULTS Less than 1% (~ 175,000 individuals) of adults residing in Canadian communities reported dementia, 5% (~ 1.5 million individuals) reported heart disease, and more than 1% (~ 370,000 individuals) reported stroke annually from 2016 to 2021. Overall, the age-standardized prevalence for stroke decreased minimally from 2016 to 2021 (p = 0.0004). Although the age-standardized prevalence of heart disease and dementia decreased from 2016 to 2018, subsequent increases in prevalence from 2018 to 2021 led to a lack of overall statistically significant changes from 2016 to 2021 (p = 0.10 for heart disease and p = 0.37 for dementia). CONCLUSION Recent increases in the prevalence of dementia, heart disease and stroke in Canadian communities threaten to reverse any gains in vascular disease prevention over the past six years. Findings reveal the urgent need for intensified prevention efforts that are community-based with a focus on joint reduction in the shared risk factors contributing to all three diseases.
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Affiliation(s)
- Sarah S Singh
- Robarts Research Institute, University of Western Ontario, 100 Perth Dr, London, ON, N6A 5K8, Canada.
| | - Shiran Zhong
- Department of Geography, University of Western Ontario, London, ON, Canada
| | - Kem A Rogers
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Vladimir C Hachinski
- Robarts Research Institute, University of Western Ontario, 100 Perth Dr, London, ON, N6A 5K8, Canada
- Department of Clinical Neurological Sciences, and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Stephanie J Frisbee
- Department of Pathology & Laboratory Medicine, and Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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Rivier CA, Szejko N, Renedo D, Noche RB, Acosta JN, Both CP, Sharma R, Torres-Lopez VM, Payabvash S, de Havenon A, Sheth KN, Gill TM, Falcone GJ. Polygenic Susceptibility to Hypertension and Cognitive Performance in Middle-aged Persons Without Stroke or Dementia. Neurology 2023; 101:e512-e521. [PMID: 37295956 PMCID: PMC10401683 DOI: 10.1212/wnl.0000000000207427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/04/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mounting evidence indicates that hypertension leads to a higher risk of dementia. Hypertension is a highly heritable trait, and a higher polygenic susceptibility to hypertension (PSH) is known to associate with a higher risk of dementia. We tested the hypothesis that a higher PSH leads to worse cognitive performance in middle-aged persons without dementia. Confirming this hypothesis would support follow-up research focused on using hypertension-related genomic information to risk-stratify middle-aged adults before hypertension develops. METHODS We conducted a nested cross-sectional genetic study within the UK Biobank (UKB). Study participants with a history of dementia or stroke were excluded. We categorized participants as having low (≤20th percentile), intermediate, or high (≥80th percentile) PSH according to results of 2 polygenic risk scores for systolic and diastolic blood pressure (BP) generated with data on 732 genetic risk variants. A general cognitive ability score was calculated as the first component of an analysis that included the results of 5 cognitive tests. Primary analyses focused on Europeans, and secondary analyses included all race/ethnic groups. RESULTS Of the 502,422 participants enrolled in the UKB, 48,118 (9.6%) completed the cognitive evaluation, including 42,011 (8.4%) of European ancestry. Multivariable regression models using systolic BP-related genetic variants indicated that compared with study participants with a low PSH, those with intermediate and high PSH had reductions of 3.9% (β -0.039, SE 0.012) and 6.6% (β -0.066, SE 0.014), respectively, in their general cognitive ability score (p < 0.001). Secondary analyses including all race/ethnic groups and using diastolic BP-related genetic variants yielded similar results (p < 0.05 for all tests). Analyses evaluating each cognitive test separately indicated that reaction time, numeric memory, and fluid intelligence drove the association between PSH and general cognitive ability score (all individual tests, p < 0.05). DISCUSSION Among nondemented, community-dwelling, middle-aged Britons, a higher PSH is associated with worse cognitive performance. These findings suggest that genetic predisposition to hypertension influences brain health in persons who have not yet developed dementia. Because information on genetic risk variants for elevated BP is available long before the development of hypertension, these results lay the foundation for further research focused on using genomic data for the early identification of high-risk middle-aged adults.
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Affiliation(s)
- Cyprien A Rivier
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
| | - Natalia Szejko
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Daniela Renedo
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Rommell B Noche
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Julian N Acosta
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Cameron P Both
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Richa Sharma
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Victor M Torres-Lopez
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Sam Payabvash
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Guido J Falcone
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
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Sabharwal R, Chapleau MW, Gerhold TD, Baumbach GL, Faraci FM. Plasticity of cerebral microvascular structure and mechanics during hypertension and following recovery of arterial pressure. Am J Physiol Heart Circ Physiol 2022; 323:H1108-H1117. [PMID: 36269650 PMCID: PMC9678426 DOI: 10.1152/ajpheart.00292.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
Changes in vascular structure contribute to vascular events and loss of brain health. We examined changes in cerebral arterioles at the onset of hypertension and the hypothesis that alterations during hypertension would recover with the return of mean arterial pressure (MAP) to normal. MAP was measured with radiotelemetry in awake male C57BL/6J mice at baseline and during infusion of vehicle or angiotensin II (ANG II, 1.4 mg/kg/day using osmotic pumps) for 28 days, followed by a 28-day recovery. With ANG II treatment, MAP increased through day 28. On day 30, MAP began to recover, reaching levels not different from vehicle on day 37. We measured intravascular pressure, diameter, wall thickness (WT), wall:lumen ratio (W:L), cross-sectional area (CSA), and slope of the tangential elastic modulus (ET) in maximally dilated arterioles. Variables were similar in both groups at day 1, with no significant change with vehicle treatment. With ANG II treatment, CSA, WT, and W:L increased on days 7-28. Internal and external diameter was reduced at 14 and 28 days. ET versus wall stress was reduced on days 7-28. During recovery, the diameter remained at days 14 and 28 values, whereas other variables returned partly or completely to normal. Thus, CSA, WT, W:L, and ET versus wall stress changed rapidly during hypertension and recovered with MAP. In contrast, inward remodeling developed slowly and did not recover. This lack of recovery has mechanistic implications for the long-term impact of hypertension on vascular determinants of brain health.NEW & NOTEWORTHY Changes in vascular structure contribute to vascular events and loss of brain health. We examined the inherent structural plasticity of cerebral arterioles during and after a period of hypertension. Arteriolar wall thickness, diameter, wall-to-lumen ratio, and biological stiffness changed rapidly during hypertension and recovered with blood pressure. In contrast, inward remodeling developed slowly and did not recover. This lack of recovery of arteriolar diameter has implications for the long-term impact of hypertension on vascular determinants of brain health.
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Affiliation(s)
- Rasna Sabharwal
- Department of Internal Medicine, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
- Department of Neuroscience and Pharmacology, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
| | - Mark W Chapleau
- Department of Internal Medicine, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
| | - Thomas D Gerhold
- Department of Internal Medicine, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
| | - Gary L Baumbach
- Department of Pathology, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
| | - Frank M Faraci
- Department of Internal Medicine, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
- Department of Neuroscience and Pharmacology, Carver College of Medicine, Francois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa
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Hachinski V. We are preventing some dementias now-But how? The Potamkin lecture. Alzheimers Dement 2022; 19:1067-1072. [PMID: 36134730 DOI: 10.1002/alz.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/09/2022]
Abstract
Most dementias are untreatable and their prevalence is increasing around the world. However, the incidence of dementia is declining in some countries. We need to find out urgently why and how and apply the lessons promptly and widely. Given the multiplicity and variability of environmental, socioeconomic, and individual risk and protective factors, the approach needs to be comprehensive, customized to work in a particular setting, and cost effective, to justify the needed funding. Stroke, heart disease, and dementia share the same major preventable risk and protective factors and pose risks for each other. Preventing them together might result in efficiencies and economies of scale. Prevention can best occur in existing actionable population health units through established leaders in government, non-governmental organizations, and the community, around a positive message of promoting brain health as the key to health, productivity, and well-being.
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Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, Robarts Research Institute and University of Western Ontario, London, Ontario, Canada
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Abstract
The pandemic is transforming neurology. Long Covid will linger, neurological diseases will increase, and technology, artificial intelligence and new virtual worlds will usher a new age of the brain and new roles for neurologists.The pandemic has compelled international collaboration, greatly increased communications and accelerated drug and vaccines approvals. It also dramatized the close interconnection of cognitive, mental, and social health and their relevance to building back better health, education, work and leisure. Brain health is the key to health, productivity, and well-being.Neurologists are best placed to lead brain knowledge integration and application through the unifying theme of brain health by becoming advocates, healers, and guardians of the brain.
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Affiliation(s)
- Vladimir Hachinski
- Vladimir Hachinski, Robarts Research Institute; Department of Clinical Neurological Sciences, University of Western Ontario
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Hachinski V, Avan A. From Dementia to Eumentia: A New Approach to Dementia Prevention. Neuroepidemiology 2022; 56:151-156. [PMID: 35613542 DOI: 10.1159/000525219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND During the past 40 years, dementia prevention approaches have ranged from searching for a drug to prevent progression to Alzheimer's disease to prevention of dementia through multi-domain lifestyle interventions. Current Approaches: The search for a silver bullet has yielded good science but no clinical results. The multi-model lifestyle intervention approach has shown encouraging results. The largest proportion of resources in prevention have been devoted to finding a drug to prevent, mitigate or delay what is being called "Alzheimer's disease of late onset." The reality is that Alzheimer pathology is common among the elderly, but it seldom only occurs alone. The only treatable and preventable pathology currently is vascular. Hence arose the concept of "vascular cognitive impairment" meaning any vascular cause or risk factor associated with cognitive impairment. The majority of cases of cognitive in the elderly have a vascular component that is treatable and preventable and identifiable by several means, including a simple ischemic score. CONCLUSION Since environmental, socioeconomic and individual risk factors contribute to dementia, we proposed a Comprehensive, Customized, Cost-effective APProach (The CCC-APP) implemented in actionable units with the focus on promoting brain health (eumentia).
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Affiliation(s)
- Vladimir Hachinski
- Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Abolfazl Avan
- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Family Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Hachinski V. Brain health: The time has come. Eur J Neurol 2022; 29:2553-2554. [PMID: 35599629 DOI: 10.1111/ene.15414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, Robarts Research Institute and University of Western Ontario, London, ON, Canada
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Hachinski V. The comprehensive, customized, cost-effective approach (CCCAP) to prevention of dementia. Alzheimers Dement 2022; 18:1565-1568. [PMID: 35103397 DOI: 10.1002/alz.12586] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/26/2022]
Abstract
The Food and Drug Administration's controversial approval of aducanumab has sounded a wake-up call. Is the search of a silver bullet to stop Alzheimer's disease the only way to prevent dementia? The controversies and costs have opened minds to alternative approaches, the most promising being that we are already preventing some dementias in some high-income countries but do not know yet how. This article proposes one way. It requires that the approach be (1) comprehensive, taking into account all relevant environmental, socioeconomic, and individual risk and protective factors; (2) customized, because contributing factors vary by region and among individuals; and (3) cost effective, implemented in actionable units. Savings of scale could occur by preventing stroke, heart disease, and dementia together. They share the same risk factors and pose risks for each other. Brain health could be the unifying, motivating, and actionable key to health, productivity, and well-being.
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Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
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Gong J, Harris K, Tzourio C, Harrap S, Naismith S, Anderson CS, Chalmers J, Woodward M. Sex differences in predictors for cognitive decline and dementia in people with stroke or transient ischemic attack in the PROGRESS trial. Int J Stroke 2021; 17:17474930211059298. [PMID: 34791978 DOI: 10.1177/17474930211059298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke and transient ischemic attack confer greater risk of cognitive decline and dementia. AIMS We used data from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a blood pressure-lowering randomized controlled trial in stroke/transient ischemic attack. We evaluated overall and sex-specific differences in treatment effects for cognitive decline/dementia, as well as associations with vascular and stroke-specific predictors,considering death as a competing risk. METHODS Multinomial logistic regression was used to estimate overall and sex-specific odds ratios (OR) (95% confidence intervals (CI)) for treatment effects and predictors associated with the risk of cognitive decline/dementia, and the women-to-men ratio of odds ratio (RORs). RESULTS Over a median four years, 763 cognitive decline/dementia (30.9% women) were recorded in 5888 participants. Women had lower odds of cognitive decline/dementia than men (OR 0.78, 95%CI 0.63-0.95). Active treatment was associated with lower odds of cognitive decline/dementia (0.84, 0.72-0.98), with no evidence of sex difference. Higher education (0.96,0.94-0.98 (per year)) and baseline Mini-Mental State Examination (MMSE)) were associated with lower odds of cognitive decline/dementia (0.84,0.82-0.86 (per point higher)). Higher diastolic blood pressure (1.11,1.02-1.20 (per 10 mmHg)), low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (1.27,1.03-1.58), and peripheral arterial disease (1.78,1.26-2.52) were associated with higher odds of cognitive decline/dementia. APOE ɛ4 was not associated with cognitive decline/dementia (1.05 (0.85-1.30)). Low eGFR was more strongly associated with cognitive decline/dementia in women than men (RORs, 1.60 (1.03-2.48)). Diabetes was more strongly associated with men than women. CONCLUSIONS Several risk factors were associated with cognitive decline/dementia in people with prior stroke/transient ischemic attack, with notable sex differences. Long-term cognitive sequelae of stroke should be considered to strengthen joint prevention strategies for stroke, cognitive decline, and dementia.Trial Registration: This trial was not registered because enrolment began before 1 July 2005.
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Affiliation(s)
- Jessica Gong
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katie Harris
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Christophe Tzourio
- Bordeaux Population Health Research Center, Bordeaux University, INSERM, Bordeaux, France
- Hospital Center Bordeaux University, Bordeaux, France
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Melbourne, Australia
| | - Sharon Naismith
- School of Psychology, University of Sydney, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Craig S Anderson
- George Institute China, Peking University Health Science Center, Beijing, China
- Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia
- Heart Health Research Center, Beijing, China
| | - John Chalmers
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Imperial College London, London, UK
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Avan A, Hachinski V. Brain health: Key to health, productivity, and well-being. Alzheimers Dement 2021; 18:1396-1407. [PMID: 34569702 DOI: 10.1002/alz.12478] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Brain health is essential for physical and mental health, social well-being, productivity, and creativity. Current neurological research focuses mainly on treating a diseased brain and preventing further deterioration rather than on developing and maintaining brain health. The pandemic has forced a shift toward virtual working environments that accelerated opportunities for transdisciplinary collaboration for fostering brain health among neurologists, psychiatrists, psychologists, neuro and socio-behavioral scientists, scholars in arts and humanities, policymakers, and citizens. This could shed light on the interconnectedness of physical, mental, environmental, and socioeconomic determinants of brain disease and health. We advocate making brain health the top priority worldwide, developing common measures and definitions to enhance research and policy, and finding the cause of the decline of incidence of stroke and dementia in some countries and then applying comprehensive customized cost-effective prevention solutions in actionable implementation units. Life cycle brain health offers the best single individual, communal, and global investment.
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Affiliation(s)
- Abolfazl Avan
- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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22
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Abstract
Hypertension is a leading cause of cognitive impairment and dementias. Such loss of brain health has a vascular component, but the mechanisms involved are poorly defined. In this issue of the JCI, Koide et al. provide evidence that end-organ effects of hypertension on capillary endothelium and inward-rectifier K+ channels (Kir2.1) impair integrated propagation of electrical signals and vasodilation upstream, resulting in reduced neurovascular coupling (NVC) despite neural activation. NVC was partly restored by amlodipine, but not losartan. Moreover, NVC was improved by eplerenone in the presence of losartan, suggesting a role for aldosterone. These findings support the concept that endothelial cells and Kir2.1 are potential therapeutic targets to prevent or reverse the loss of NVC and the vascular component of cognitive deficits that occur with increased frequency during hypertension.
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