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L'Écuyer S, Charbonney E, Carrier FM, Rose CF. Implication of Hypotension in the Pathogenesis of Cognitive Impairment and Brain Injury in Chronic Liver Disease. Neurochem Res 2024; 49:1437-1449. [PMID: 36635437 DOI: 10.1007/s11064-022-03854-z] [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: 07/25/2022] [Revised: 09/23/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023]
Abstract
The incidence of chronic liver disease is on the rise. One of the primary causes of hospital admissions for patients with cirrhosis is hepatic encephalopathy (HE), a debilitating neurological complication. HE is defined as a reversible syndrome, yet there is growing evidence stating that, under certain conditions, HE is associated with permanent neuronal injury and irreversibility. The pathophysiology of HE primarily implicates a strong role for hyperammonemia, but it is believed other pathogenic factors are involved. The fibrotic scarring of the liver during the progression of chronic liver disease (cirrhosis) consequently leads to increased hepatic resistance and circulatory anomalies characterized by portal hypertension, hyperdynamic circulatory state and systemic hypotension. The possible repercussions of these circulatory anomalies on brain perfusion, including impaired cerebral blood flow (CBF) autoregulation, could be implicated in the development of HE and/or permanent brain injury. Furthermore, hypotensive insults incurring during gastrointestinal bleed, infection, or liver transplantation may also trigger or exacerbate brain dysfunction and cell damage. This review will focus on the role of hypotension in the onset of HE as well as in the occurrence of neuronal cell loss in cirrhosis.
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Affiliation(s)
- Sydnée L'Écuyer
- Hepato-Neuro Laboratory, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis - Pavillon R, R08.422 Montréal (Québec), Québec, H2X 0A9, Canada
| | - Emmanuel Charbonney
- Department of Medicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - François Martin Carrier
- Department of Medicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Carrefour de l'innovation et santé des populations , Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Christopher F Rose
- Hepato-Neuro Laboratory, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis - Pavillon R, R08.422 Montréal (Québec), Québec, H2X 0A9, Canada.
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Mei Y, Christensen GM, Li Z, Waller LA, Ebelt S, Marcus M, Lah JJ, Wingo AP, Wingo TS, Hüls A. Joint effects of air pollution and neighborhood socioeconomic status on cognitive decline - Mediation by depression, high cholesterol levels, and high blood pressure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 923:171535. [PMID: 38453069 DOI: 10.1016/j.scitotenv.2024.171535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
Air pollution and neighborhood socioeconomic status (N-SES) are associated with adverse cardiovascular health and neuropsychiatric functioning in older adults. This study examines the degree to which the joint effects of air pollution and N-SES on the cognitive decline are mediated by high cholesterol levels, high blood pressure (HBP), and depression. In the Emory Healthy Aging Study, 14,390 participants aged 50+ years from Metro Atlanta, GA, were assessed for subjective cognitive decline using the cognitive function instrument (CFI). Information on the prior diagnosis of high cholesterol, HBP, and depression was collected through the Health History Questionnaire. Participants' census tracts were assigned 3-year average concentrations of 12 air pollutants and 16 N-SES characteristics. We used the unsupervised clustering algorithm Self-Organizing Maps (SOM) to create 6 exposure clusters based on the joint distribution of air pollution and N-SES in each census tract. Linear regression analysis was used to estimate the effects of the SOM cluster indicator on CFI, adjusting for age, race/ethnicity, education, and neighborhood residential stability. The proportion of the association mediated by high cholesterol levels, HBP, and depression was calculated by comparing the total and direct effects of SOM clusters on CFI. Depression mediated up to 87 % of the association between SOM clusters and CFI. For example, participants living in the high N-SES and high air pollution cluster had CFI scores 0.05 (95 %-CI:0.01,0.09) points higher on average compared to those from the high N-SES and low air pollution cluster; after adjusting for depression, this association was attenuated to 0.01 (95 %-CI:-0.04,0.05). HBP mediated up to 8 % of the association between SOM clusters and CFI and high cholesterol up to 5 %. Air pollution and N-SES associated cognitive decline was partially mediated by depression. Only a small portion (<10 %) of the association was mediated by HBP and high cholesterol.
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Affiliation(s)
- Yiyang Mei
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Grace M Christensen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefanie Ebelt
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Aliza P Wingo
- Division of Mental Health, Atlanta VA Medical Center, Decatur, GA, USA; Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas S Wingo
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA; Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Huang H, Zhan Y, Yu L, Li S, Cai X. Association between Blood Pressure and Post-Stroke Cognitive Impairment: A Meta-Analysis. Rev Cardiovasc Med 2024; 25:174. [PMID: 39076476 PMCID: PMC11267189 DOI: 10.31083/j.rcm2505174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 07/31/2024] Open
Abstract
Background Post-stroke cognitive impairment (PSCI) represents a serious post-stroke complication with poor cognitive consequences. A vascular consequence after a stroke is that the occurrence and progression of PSCI may be closely related to blood pressure (BP). Thus, we systematically reviewed and performed a meta-analysis of the literature to examine the correlations between BP and PSCI. Methods We systematically queried databases, including PubMed, the Cochrane Library, Embase, and Scopus, and conducted meta-analyses on studies reporting odds ratios (ORs) related to the association between BP and PSCI. Two authors autonomously assessed all titles, abstracts, and full texts and extracted data following the Meta-Analysis of Observational Studies in Epidemiology guidelines. The quality of the studies was evaluated using the modified Newcastle-Ottawa scale. Results Meta-analyses incorporated 12 articles comprising a cumulative participant cohort of 21,732 individuals. The quality assessment indicated good in five studies, fair in one study, and poor in six. Through meta-analyses, we found that hypertension, systolic or diastolic BP (SBP or DBP) was significantly associated with PSCI (OR 1.53, 95% confidence interval (CI), 1.18-1.99; p = 0.001, I 2 = 66%; OR 1.13, 95% CI, 1.05-1.23; p = 0.002, I 2 = 52%; OR 1.38, 95% CI, 1.11-1.72; p = 0.004, I 2 = 90%, respectively). In the subgroup analysis, SBP < 120 mmHg, 120-139 mmHg, 140-159 mmHg, 160-179 mmHg, and DBP ≥ 100 mmHg highly predicted the occurrence of PSCI (OR 1.15, p = 0.0003; OR 1.26, p = 0.010; OR 1.15, p = 0.05; OR 1.02, p = 0.009; OR 1.96, p < 0.00001, respectively). However, the predictive effect of BP for PSCI declines when SBP ≥ 180 mmHg and DBP ≤ 99 mmHg (p > 0.05). Statistical heterogeneity was moderate to high, and publication bias was detected in SBP for PSCI. Conclusions Considering the multifactorial etiology of PSCI, it is difficult to conclude that BP is an independent risk factor for PSCI. Given the restricted inclusion of studies, caution is advised when interpreting the findings from this meta-analysis. Subsequent investigations with substantial sample sizes are essential to exploring BP as a prospective target for addressing PSCI. Trial Registration Number CRD42023437783 from PROSPERO.
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Affiliation(s)
- Huifen Huang
- Neurology Department of Lishui Municipal Central Hospital, 323000 Lishui, Zhejiang, China
| | - Yanli Zhan
- Lishui Cardio-Cerebrovascular Disease Prevention Center, 323000 Lishui, Zhejiang, China
| | - Linling Yu
- Neurology Department of Lishui Municipal Central Hospital, 323000 Lishui, Zhejiang, China
| | - Shan Li
- Lishui Cardio-Cerebrovascular Disease Prevention Center, 323000 Lishui, Zhejiang, China
| | - Xueli Cai
- Neurology Department of Lishui Municipal Central Hospital, 323000 Lishui, Zhejiang, China
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Xie C, Zhong D, Zhang Y, Liu X, Zhang L, Luo X, Gong Y, Jiang W, Jin R, Li J. Prevalence and risk factors of cognitive impairment in Chinese patients with hypertension: a systematic review and meta-analysis. Front Neurol 2024; 14:1271437. [PMID: 38414728 PMCID: PMC10898355 DOI: 10.3389/fneur.2023.1271437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/31/2023] [Indexed: 02/29/2024] Open
Abstract
Background Cognitive impairment is prevalent in Chinese patients with hypertension; however, current evidence on prevalence and risk factors is required to be synthesized. Objectives This systematic review and meta-analysis aimed to evaluate the prevalence and risk factors of cognitive impairment in Chinese patients with hypertension. Methods Two reviewers independently searched PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, the Wanfang database, and the VIP database from their inception to 7 June 2023. The gray literature and the reference lists of the included studies were also retrieved manually. Moreover, we also independently performed the eligibility screening, data extraction, and data synthesis. The primary outcome was the prevalence of cognitive impairment in Chinese patients with hypertension, and the secondary outcomes were the risk factors for cognitive impairment in patients with hypertension. R (version 4.0.3) was used for data synthesis. Results In total, 82 studies involving 53,623 patients with hypertension were included in this meta-analysis. The pooled prevalence of cognitive impairment in patients with hypertension was 37.6% (95% CI: 33.2-42.2%). A total of 12 risk factors, including advanced age (r = -0.34, 95% CI: -0.45, -0.21), female sex (OR = 1.15, 95% CI: 1.01-1.32), BMI > 24 Kg/m2 (OR = 1.76, 95% CI: 1.04-3.00), lower educational level (OR = 2.01, 95% CI: 1.10-3.67), single status (OR = 1.63, 95% CI: 1.32-2.02), complications with diabetes (OR = 1.44, 95% CI: 1.14-1.80), coronary heart disease (OR = 1.49, 95% CI: 1.12-1.97), higher stage of hypertension [stage 3 vs. stage 1, OR = 3.08, 95% CI: 1.82-5.22; stage 2 vs. stage 1, OR = 1.83, 95% CI: 1.29-2.60], no regular physical activity (OR = 0.40, 95% CI: 0.21-0.77), higher levels of systolic blood pressure (r = -0.25, 95% CI: -0.42, -0.08), Hcy (r = -0.39, 95% CI: -0.63, -0.09), and IL-6 (r = -0.26, 95% CI: -0.48, -0.02) were detected. Conclusion Cognitive impairment is prevalent in Chinese patients with hypertension, and the increased prevalence was associated with several demographic characteristics, complicated disease, no regular physical activity, worse hypertension status (higher stages and SBP), and high levels of biomarkers. Therefore, more attention should be paid to the early identification and treatment of patients with hypertension who are at high risk for cognitive impairment in clinical practice. In addition, relevant risk factors should be controlled to reduce the incidence of cognitive impairment. Systematic review registration http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42023410437].
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Affiliation(s)
- Cheng Xie
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lili Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao Luo
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yimeng Gong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Jiang
- Department of Orthopedics, Pingshan County Hospital of Traditional Chinese Medicine, Yibing, China
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Affiliated Sichuan Provincial Rehabilitation Hospital of Chengdu University of Traditional Chinese Medicine and Sichuan Provincial BAYI Rehabilitation Center, Chengdu, China
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Lyon M, Fullerton JL, Kennedy S, Work LM. Hypertension & dementia: Pathophysiology & potential utility of antihypertensives in reducing disease burden. Pharmacol Ther 2024; 253:108575. [PMID: 38052309 DOI: 10.1016/j.pharmthera.2023.108575] [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: 09/21/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023]
Abstract
Dementia is a common cause of disability and dependency among the elderly due to its progressive neurodegenerative nature. As there is currently no curative therapy, it is of major importance to identify new ways to reduce its prevalence. Hypertension is recognised as a modifiable risk factor for dementia, particularly for the two most common subtypes; vascular dementia (VaD) and Alzheimer's disease (AD). From the current literature, identified through a comprehensive literature search of PubMed and Cochrane Library, this review aims to establish the stage in adulthood when hypertension becomes a risk for cognitive decline and dementia, and whether antihypertensive treatment is effective as a preventative therapy. Observational studies generally found hypertension in mid-life (age 45-64) to be correlated with an increased risk of cognitive decline and dementia incidence, including both VaD and AD. Hypertension manifesting in late life (age ≥ 65) was demonstrated to be less of a risk, to the extent that incidences of high blood pressure (BP) in the very elderly (age ≥ 75) may even be related to reduced incidence of dementias. Despite the evidence linking hypertension to dementia, there were conflicting findings as to whether the use of antihypertensives was beneficial for its prevention and this conflicting evidence and inconsistent results could be due to the methodological differences between the reviewed observational and randomised controlled trials. Furthermore, dihydropyridine calcium channel blockers and potassium-sparing diuretics were proposed to have neuroprotective properties in addition to BP lowering. Overall, if antihypertensives are confirmed to be beneficial by larger-scale homogenous trials with longer follow-up durations, treatment of hypertension, particularly in mid-life, could be an effective strategy to considerably lower the prevalence of dementia. Furthermore, greater clarification of the neuroprotective properties that some antihypertensives possess will allow for better clinical practice guidance on the choice of antihypertensive class for both BP lowering and dementia prevention.
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Affiliation(s)
- Mara Lyon
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Josie L Fullerton
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Simon Kennedy
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Lorraine M Work
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK.
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Wang Y, Zhi H, Zhang X. Effect of Huangdisan grain on improving cognitive impairment in VD rats and its mechanism in immune inflammatory response. J Neuroimmunol 2023; 377:578058. [PMID: 36871311 DOI: 10.1016/j.jneuroim.2023.578058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Vascular dementia (VD) is the second most common type of dementia after Alzheimer's disease (AD). Although the incidence rate is very high, there is no definitive treatment for VD. And it has serious impact on the quality of life of VD patients. In recent years, more and more studies about the clinical efficacy and pharmacological effects of traditional Chinese medicine (TCM) in the treatment of VD have been conducted. And Huangdisan grain has been used to treat VD patients with a good curative effect in clinic. OBJECTIVE This study was designed to investigate the effect of Huangdisan grain on the inflammatory response and cognitive function of VD rats modeled by bilateral common carotid artery occlusion (BCCAO), that aimed to improve the treatment methods for VD. METHODS 8-week-old healthy SPF male Wistar rats (280 ± 20 g) were randomly divided into the normal group (Gn, n = 10), sham operated group (Gs, n = 10), and operated group (Go, n = 35). The VD rat models in Go group were established by BCCAO. 8 weeks after surgery, the operated rats were screened by the hidden platform trail of Morris Water Maze (MWM), and the rats with cognitive dysfunction were further randomly divided into the impaired group (Gi, n = 10) and TCM group (Gm, n = 10). The VD rats in Gm group were given the intragastric administration of Huangdisan grain decoction once a day for 8 weeks, and the other groups were given intragastric administration of normal saline. Then the cognitive ability of rats in each group was detected by the MWM Test. The lymphocyte subsets in peripheral blood and hippocampus of rats were measured by flow cytometry. The levels of cytokines (IL-1β, IL-2, IL-4, IL-10, TNF-α, INF-γ, MIP-2, COX-2, iNOS) in peripheral blood and hippocampus were measured by ELISA (enzyme linked immunosorbent assay). The number of Iba-1+ CD68+ co-positive cells in the CA1 region of hippocampus was measured by immunofluorescence. RESULTS Compared with the Gn group, the escape latencies of the Gi group were prolonged (P < 0.01), the time spent in the former platform quadrant was shortened (P < 0.01), and the number of times of crossing over the former platform location was reduced (P < 0.05). But compared with the Gi group, the escape latencies of Gm group were shortened (P < 0.01), the time spent in the former platform quadrant was prolonged (P < 0.05), and the number of times of crossing over the former platform location was increased (P < 0.05). The number of Iba-1+ CD68+ co-positive cells in the CA1 region of hippocampus of VD rats in Gi group was increased (P < 0.01) compared with the Gn group. And the proportions of T Cells, CD4+ T Cells, CD8+ T Cells in the hippocampus were increased (P < 0.01). The level of pro-inflammatory cytokines in the hippocampus was increased significantly, such as IL-1β (P < 0.01), IL-2 (P < 0.01), TNF-α (P < 0.05), IFN-γ (P < 0.01), COX-2 (P < 0.01), MIP-2 (P < 0.01) and iNOS (P < 0.05). And the level of IL-10 (P < 0.01), a kind of anti-inflammatory cytokine, was decreased. The proportions of T Cells (P < 0.05), CD4+ T Cells (P < 0.01) and NK Cells (P < 0.05) in the peripheral blood of the VD rats in Gi group were decreased, and the level of IL-1β, IL-2, TNF-α, IFN-γ, COX-2, MIP-2 and iNOS was increased significantly (P < 0.01) compared with the Gn group. Meanwhile, the level of IL-4 and IL-10 was decreased (P < 0.01). Huangdisan grain could reduce the number of Iba-1+ CD68+ co-positive cells in the CA1 region of hippocampus (P < 0.01), decrease the proportions of T Cells, CD4+ T Cells, CD8+ T Cells and the level of IL-1β, MIP-2 in hippocampus (P < 0.01) of VD rats. Moreover, it could rise the proportion of NK Cells (P < 0.01) and the level of IL-4 (P < 0.05), IL-10 (P < 0.05), and decrease the level of IL-1β (P < 0.01), IL-2 (P < 0.05), TNF-α (P < 0.01), IFN-γ (P < 0.01), COX-2 (P < 0.01) and MIP-2 (P < 0.01) in peripheral blood of VD rats. CONCLUSION This study indicated that Huangdisan grain could decrease the activation of microglia/macrophages, regulate the proportions of lymphocyte subsets and the level of cytokines, which could adjust the immunologic abnormalities of VD rats, and ultimately improve cognitive function.
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Affiliation(s)
- Yao Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300380, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300380, China
| | - Hui Zhi
- The Ninth People's Hospital of Chongqing, Chongqing 400799, China
| | - Xuezhu Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300380, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300380, China.
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Nguyen TN, Kalia S, Hanlon P, Jani BD, Nicholl BI, Christie CD, Aliarzadeh B, Moineddin R, Harrison C, Chow C, Fortin M, Mair FS, Greiver M. Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada. J Prim Care Community Health 2023; 14:21501319231215025. [PMID: 38097504 PMCID: PMC10725138 DOI: 10.1177/21501319231215025] [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: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control. METHODS This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019. Uncontrolled BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. A list of 11 a priori selected chronic conditions was used to define multimorbidity. Multimorbidity was defined as having ≥1 long-term condition in addition to hypertension. Logistic regression models were used to estimate the association between multimorbidity (or individual long-term conditions) with uncontrolled BP. RESULTS A total of 67 385 patients with hypertension were included. They had a mean age of 70, 53.1% were female, 80.6% had multimorbidity, and 35.7% had uncontrolled BP. Patients with multimorbidity had lower odds of uncontrolled BP than those without multimorbidity (adjusted OR = 0.72, 95% CI 0.68-0.76). Among the long-term conditions, diabetes (aOR = 0.73, 95%CI 0.70-0.77), heart failure (aOR = 0.81, 95%CI 0.73-0.91), ischemic heart disease (aOR = 0.74, 95%CI 0.69-0.79), schizophrenia (aOR = 0.79, 95%CI 0.65-0.97), depression/anxiety (aOR = 0.91, 95%CI 0.86-0.95), dementia (aOR = 0.87, 95%CI 0.80-0.95), and osteoarthritis (aOR = 0.89, 95%CI 0.85-0.93) were associated with a lower likelihood of uncontrolled BP. CONCLUSION We found that multimorbidity was associated with better BP control. Several conditions were associated with better control, including diabetes, heart failure, ischemic heart disease, schizophrenia, depression/anxiety, dementia, and osteoarthritis.
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Affiliation(s)
- Tu N. Nguyen
- University of Sydney, Sydney, NSW, Australia
- University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | - Clara Chow
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Michelle Greiver
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
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Richards M. The Power of Birth Cohorts to Study Risk Factors for Cognitive Impairment. Curr Neurol Neurosci Rep 2022; 22:847-854. [PMID: 36350423 PMCID: PMC9643995 DOI: 10.1007/s11910-022-01244-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE OF REVIEW Birth cohorts are studies of people the same time; some of which have continuously followed participants across the life course. These are powerful designs for studying predictors of age-related outcomes, especially when information on predictors is collected before these outcomes are known. This article reviews recent findings from these cohorts for the outcomes of cognitive function, cognitive impairment, and risk of dementia, in relation to prior cognitive function, and social and biological predictors. RECENT FINDINGS Cognitive function and impairment are predicted by a wide range of factors, including childhood cognition, education, occupational status and complexity, and biological factors, including genetic and epigenetic. The particular importance of high and rising blood pressure in midlife is highlighted, with some insight into brain mechanisms involved. Some limitations are noted, including sources of bias in the data. Despite these limitations, birth cohorts have provided valuable insights into factors across the life course associated with cognitive impairment.
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Affiliation(s)
- Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Feasibility of Precision Medicine in Hypertension Management-Scope and Technological Aspects. J Pers Med 2022; 12:jpm12111861. [PMID: 36573720 PMCID: PMC9698650 DOI: 10.3390/jpm12111861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Personalized management of diseases by considering relevant patient features enables optimal treatment, instead of management according to an average patient. Precision management of hypertension is important, because both susceptibility to complications and response to treatment vary between individuals. While the use of genomic and proteomic personal features for widespread precision hypertension management is not practical, other features, such as age, ethnicity, and cardiovascular diseases, have been utilized in guidelines for hypertension management. In precision medicine, more blood-pressure-related clinical and physiological characteristics in the patient's profile can be utilized for the determination of the threshold of hypertension and optimal treatment. Several non-invasive and simple-to-use techniques for the measurement of hypertension-related physiological features are suggested for use in precision management of hypertension. In order to provide precise management of hypertension, accurate measurement of blood pressure is required, but the available non-invasive blood pressure measurement techniques, auscultatory sphygmomanometry and oscillometry, have inherent significant inaccuracy-either functional or technological-limiting the precision of personalized management of hypertension. A novel photoplethysmography-based technique for the measurement of systolic blood pressure that was recently found to be more accurate than the two available techniques can be utilized for more precise and personalized hypertension management.
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Yu Y, Gu M, Huang H, Cheng S, Deng Y, Cai C, Chen X, Niu H, Ning X, Hua W. Combined association of triglyceride-glucose index and systolic blood pressure with all-cause and cardiovascular mortality among the general population. Lab Invest 2022; 20:478. [PMID: 36266665 PMCID: PMC9583494 DOI: 10.1186/s12967-022-03678-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022]
Abstract
Background The combined association of triglyceride-glucose (TyG) index and different systolic blood pressure (SBP) levels with all-cause and cardiovascular mortality among the general population remains unclear. Methods In this study, 6245 individuals were from the National Health and Nutrition Examination Survey (1999–2002). The study endpoints were all-cause and cardiovascular mortality. Multivariate Cox proportional hazards regression models were used to explore the combined association of TyG index and different SBP levels with all-cause and cardiovascular mortality. Results During a mean follow-up period of 66.8 months, a total of 284 all-cause deaths (331/100000 person-years) and 61 cardiovascular deaths (66/100000 person-years) were recorded. Multivariate Cox regression analysis revealed that the combination of low TyG index and low SBP (< 120 mmHg and < 130 mmHg) was associated with a reduced risk of all-cause and cardiovascular mortality than others. However, survival benefit was not observed in the combined group with the low TyG index and SBP < 140 mmHg. Furthermore, the mortality rate in the combined group of low TyG index and low SBP gradually increased with the elevation of SBP level. Conclusion The combination of low TyG index and low SBP (< 120 mmHg and < 130 mmHg) was associated with a lower risk of all-cause and cardiovascular mortality. However, no survival benefit was observed in the combined group of low TyG index and SBP < 140 mmHg. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03678-z.
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Affiliation(s)
- Yu Yu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Min Gu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Hao Huang
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Sijing Cheng
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Yu Deng
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Chi Cai
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Xuhua Chen
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Hongxia Niu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Xiaohui Ning
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union MedicalCollege, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China.
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11
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Hwangbo S, Kim YJ, Park YH, Kim HJ, Na DL, Jang H, Seo SW. Relationships between educational attainment, hypertension, and amyloid negative subcortical vascular dementia: The brain-battering hypothesis. Front Neurosci 2022; 16:934149. [PMID: 35992915 PMCID: PMC9388911 DOI: 10.3389/fnins.2022.934149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Many epidemiological studies suggest that lower education levels and vascular risk factors increase the likelihood of developing Alzheimer's disease dementia (ADD) and subcortical vascular dementia (SVaD). However, whether the brain-battering hypothesis can explain the relationship between education levels and the clinical diagnosis of dementia remains controversial. The objective of this study was to investigate whether vascular risk factors mediate the association between education level and the diagnosis of amyloid-beta positive (Aβ+) ADD and amyloid-beta negative (Aβ-) SVaD. Methods We analyzed 376 participants with Aβ normal cognition (Aβ- NC), 481 with Aβ+ ADD, and 102 with Aβ- SVaD. To investigate the association of education level and vascular risk factors with these diagnoses, multivariable logistic regression analysis was used, with age, sex, and APOE ε4 carrier status used as covariates. Path analysis was performed to investigate the mediation effects of hypertension on the diagnosis of Aβ- SVaD. Results The Aβ- SVaD group (7.9 ± 5.1 years) had lower education levels than did the Aβ- NC (11.8 ± 4.8 years) and Aβ+ ADD (11.2 ± 4.9 years) groups. The frequencies of hypertension and diabetes mellitus were higher in the Aβ- SVaD group (78.4 and 32.4%, respectively) than in the Aβ- NC (44.4 and 20.8%) and Aβ+ ADD (41.8 and 15.8%, respectively) groups. Increased education level was associated with a lower risk of Aβ- SVaD [odds ratio (OR) 0.866, 95% confidence interval (CI), 0.824–0.911], but not Aβ+ ADD (OR 0.971, 95% CI 0.940–1.003). The frequency of hypertension was associated with a higher risk of developing Aβ- SVaD (OR 3.373, 95% CI, 1.908–5.961), but not Aβ+ ADD (OR 0.884, 95% CI, 0.653–1.196). In the path analysis, the presence of hypertension partially mediated the association between education level and the diagnosis of Aβ- SVaD. Conclusion Our findings revealed that education level might influence the development of Aβ- SVaD through the brain-battering hypothesis. Furthermore, our findings suggest that suitable strategies, such as educational attainment and prevention of hypertension, are needed for the prevention of Aβ- SVaD.
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Affiliation(s)
- Song Hwangbo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Young Ju Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Yu Hyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Samsung Alzheimer Convergence Research Center, Samsung Medical Center, Seoul, South Korea
- *Correspondence: Hyemin Jang
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Samsung Alzheimer Convergence Research Center, Samsung Medical Center, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University School of Medicine, Suwon, South Korea
- Sang Won Seo ;
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12
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de Havenon A, Anadani M, Prabhakaran S, Wong KH, Yaghi S, Rost N. Increased Blood Pressure Variability and the Risk of Probable Dementia or Mild Cognitive Impairment: A Post Hoc Analysis of the SPRINT MIND Trial. J Am Heart Assoc 2021; 10:e022206. [PMID: 34533059 PMCID: PMC8649507 DOI: 10.1161/jaha.121.022206] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Increased systolic blood pressure variability (BPV) is associated with stroke, cardiovascular disease, and dementia and mild cognitive impairment. However, prior studies assessing the relationship between BPV and dementia or mild cognitive impairment had infrequent measurement of blood pressure or suboptimal blood pressure control. Methods and Results We performed a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) MIND (Memory and Cognition in Decreased Hypertension) trial. The primary outcome was probable dementia during follow‐up. We defined our exposure period, during which blood pressures were collected, as the first 600 days of the trial, and outcomes were ascertained during the subsequent follow‐up. BPV was measured as tertiles of systolic blood pressure standard deviation. We fit Cox proportional hazards models to our outcome. We included 8379 patients. The mean follow‐up was 3.2±1.4 years, during which 316 (3.8%) patients developed dementia. The mean number of blood pressure measurements was 7.8, and in the tertiles of BPV, the SD was 6.3±1.6, 10.3±1.1, and 16.3±3.6 mm Hg, respectively. The rate of dementia was 2.4%, 3.6%, and 5.4% by ascending tertile, respectively (P<0.001). In the Cox models, compared with the lowest tertile of BPV, the highest tertile of BPV increased the risk of dementia in both unadjusted (hazard ratio [HR], 2.36; 95% CI, 1.77–3.15) and adjusted (HR, 1.69; 95% CI, 1.25–2.28) models. Conclusions In a post hoc analysis of the SPRINT MIND trial, we found that higher BPV was associated with the development of probable dementia despite excellent blood pressure control. Additional research is needed to understand how to reduce BPV and if its reduction lowers the risk of cognitive impairment and dementia.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology University of Utah Salt Lake City UT
| | | | | | - Ka-Ho Wong
- Department of Neurology University of Utah Salt Lake City UT
| | - Shadi Yaghi
- Department of Neurology New York University New York NY
| | - Natalia Rost
- Department of Neurology Harvard University Boston MA
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Hillebrand SL, Reijnierse EM, Meskers CGM, Maier AB. Orthostatic hypotension assessed by active standing is associated with worse cognition in geriatric rehabilitation inpatients, RESORT. Arch Gerontol Geriatr 2021; 96:104482. [PMID: 34284300 DOI: 10.1016/j.archger.2021.104482] [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: 03/01/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Geriatric rehabilitation inpatients who suffer from acute and chronic diseases that aggravate blood pressure (BP) dysregulation, may be particularly susceptible to orthostatic hypotension (OH). OH may increase the risk of cerebral small vessel disease and subsequent white matter hyperintensities inducing cognitive impairment (CI). This study investigates the association between OH and cognition in geriatric rehabilitation inpatients. MATERIALS AND METHODS Geriatric rehabilitation inpatients of the observational, longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort in Melbourne, Australia, underwent intermittent BP measurements during active standing or partial postural change to sitting (when unable to stand). OH was defined as a systolic BP drop ≥20 mmHg and/or diastolic BP drop ≥10 mmHg within three minutes after postural change. CI included dementia diagnosis, Mini-Mental State Examination (MMSE) score <24 points (categorized as 18-23 (mild CI) and <18 points (severe CI)), Montreal Cognitive Assessment score <26 points or Rowland Universal Dementia Assessment Scale score <23 points. RESULTS In geriatric rehabilitation inpatients (n=1232, mean age 82.3 years (SD 8.2), 57.5% female), OH, CI and dementia prevalence was 20.0%, 61.0% and 20.4% respectively. MMSE was scored 18-23 in 32.6% and <18 points in 27.8% of patients (n=1033). In standing patients (51.7%), OH was associated with CI (p=0.045) and dementia (p=0.021), with a trend for MMSE scores <18 points (p=0.080), but not for MMSE scores 18-23 points (p=0.528). No association was found between seated OH and cognition. CONCLUSION OH assessed by active standing using intermittent BP measurements was associated with worse cognition in geriatric rehabilitation inpatients.
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Affiliation(s)
- Sarah L Hillebrand
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, City Campus, Level 6 North, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, de Boelelaan 1117, 1081 HZ Amsterdam, the Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, de Boelelaan 1117, 1081 HZ Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, City Campus, Level 6 North, 300 Grattan Street, Parkville, Victoria 3050, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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Krishnamurthy V, Sprick JD, Krishnamurthy LC, Barter JD, Turabi A, Hajjar IM, Nocera JR. The Utility of Cerebrovascular Reactivity MRI in Brain Rehabilitation: A Mechanistic Perspective. Front Physiol 2021; 12:642850. [PMID: 33815146 PMCID: PMC8009989 DOI: 10.3389/fphys.2021.642850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cerebrovascular control and its integration with other physiological systems play a key role in the effective maintenance of homeostasis in brain functioning. Maintenance, restoration, and promotion of such a balance are one of the paramount goals of brain rehabilitation and intervention programs. Cerebrovascular reactivity (CVR), an index of cerebrovascular reserve, plays an important role in chemo-regulation of cerebral blood flow. Improved vascular reactivity and cerebral blood flow are important factors in brain rehabilitation to facilitate desired cognitive and functional outcomes. It is widely accepted that CVR is impaired in aging, hypertension, and cerebrovascular diseases and possibly in neurodegenerative syndromes. However, a multitude of physiological factors influence CVR, and thus a comprehensive understanding of underlying mechanisms are needed. We are currently underinformed on which rehabilitation method will improve CVR, and how this information can inform on a patient's prognosis and diagnosis. Implementation of targeted rehabilitation regimes would be the first step to elucidate whether such regimes can modulate CVR and in the process may assist in improving our understanding for the underlying vascular pathophysiology. As such, the high spatial resolution along with whole brain coverage offered by MRI has opened the door to exciting recent developments in CVR MRI. Yet, several challenges currently preclude its potential as an effective diagnostic and prognostic tool in treatment planning and guidance. Understanding these knowledge gaps will ultimately facilitate a deeper understanding for cerebrovascular physiology and its role in brain function and rehabilitation. Based on the lessons learned from our group's past and ongoing neurorehabilitation studies, we present a systematic review of physiological mechanisms that lead to impaired CVR in aging and disease, and how CVR imaging and its further development in the context of brain rehabilitation can add value to the clinical settings.
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Affiliation(s)
- Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Justin D. Sprick
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Physics & Astronomy, Georgia State University, Atlanta, GA, United States
| | - Jolie D. Barter
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Aaminah Turabi
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Ihab M. Hajjar
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Joe R. Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
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Rouch L, Vidal JS, Hoang T, Cestac P, Hanon O, Yaffe K. Systolic blood pressure postural changes variability is associated with greater dementia risk. Neurology 2020; 95:e1932-e1940. [PMID: 32690802 DOI: 10.1212/wnl.0000000000010420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether orthostatic hypotension (OHYPO) and visit-to-visit blood pressure (BP) postural changes variability are associated with incident dementia. METHODS We studied 2,131 older adults from the Health, Aging, and Body Composition cohort study. Orthostatic BP was repeatedly assessed over a 5-year baseline period. OHYPO was defined as a fall ≥15 mm Hg in systolic or ≥7 mm Hg in diastolic BP after standing from a sitting position for one-third or more of the visits. Systolic OHYPO and diastolic OHYPO were also examined separately. BP postural changes variability over time was evaluated with several indicators, including SD and coefficient of variation (CV). Incident dementia was determined over 12 years after the baseline period by dementia medication use, ≥1.5 SD decline in Modified Mini-Mental State Examination score, or hospitalization records. RESULTS Of 2,131 participants (mean age 73 years, 53% female, 39% Black), 309 (14.5%) had OHYPO, 192 (9.0%) had systolic OHYPO, 132 (6.2%) had diastolic OHYPO, and 462 (21.7%) developed dementia. After adjustment for demographics, seated systolic BP (SBP), antihypertensive drugs, cerebrovascular disease, diabetes mellitus, depressive symptoms, smoking, alcohol, body mass index, and presence of 1 or 2 APOE ε4 alleles, systolic OHYPO was associated with greater dementia risk (adjusted hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.01-1.88), unlike diastolic OHYPO and OHYPO. SBP postural changes variability was also associated with higher dementia risk (highest tertile of variability [CV]: adjusted HR 1.35, 95% CI 1.06-1.71). CONCLUSION Systolic OHYPO and visit-to-visit SBP postural changes variability were associated with greater dementia risk. Our findings raise the question of potential preventive interventions to control orthostatic SBP and its fluctuations.
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Affiliation(s)
- Laure Rouch
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA.
| | - Jean-Sébastien Vidal
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Tina Hoang
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Philippe Cestac
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Olivier Hanon
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
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Double-blinded, placebo-controlled crossover trial to determine the effects of midodrine on blood pressure during cognitive testing in persons with SCI. Spinal Cord 2020; 58:959-969. [PMID: 32203065 PMCID: PMC7483245 DOI: 10.1038/s41393-020-0448-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/19/2022]
Abstract
Study Design: Clinical trial. Objectives: Individuals with spinal cord injury (SCI) above T6 experience impaired descending cortical control of the autonomic nervous system which predisposes them to hypotension. However, treatment of hypotension is uncommon in the SCI population because there are few safe and effective pharmacological options available. The primary aim of this investigation was to test the efficacy of a single dose of midodrine (10 mg), compared to placebo, to increase and normalize systolic blood pressure (SBP) between 110–120 mmHg during cognitive testing in hypotensive individuals with SCI. Secondary aims were to determine the effects of midodrine on cerebral blood flow velocity (CBFv) and global cognitive function. Setting: United States clinical research laboratory. Methods: Forty-one healthy hypotensive individuals with chronic (≥ 1-year post-injury) SCI participated in this 2-day study. Seated SBP, CBFv, cognitive performance were monitored before and after administration of identical encapsulated tablets, containing either midodrine or placebo. Results: Compared to placebo, midodrine increased SBP (4±13 vs. 18±24 mmHg, respectively; p<0.05); however, responses varied widely with midodrine (−15.7 to +68.6 mmHg). Further, the proportion of SBP recordings within the normotensive range did not improve during cognitive testing with midodrine compared to placebo. Although higher SBP was associated with higher CBFv (p=0.02), global cognitive function was not improved with midodrine. Conclusions: The findings indicate that midodrine increases SBP and may be beneficial in some hypotensive patients with SCI; however, large heterogeneity of responses to midodrine suggest careful monitoring of patients following administration.
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Effects of Blood Pressure on Cognitive Performance: A Systematic Review. J Clin Med 2019; 9:jcm9010034. [PMID: 31877865 PMCID: PMC7019226 DOI: 10.3390/jcm9010034] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background: High blood pressure has been associated with an increased risk of developing cognitive impairment. However, this relationship is unclear. This study aims to systematically review the effects of blood pressure on executive functioning, language, memory, attention and processing speed. Methods: The review process was conducted according to the PRISMA-Statement, using the PubMed, PsycINFO, PsycARTICLES and MEDLINE databases. Restrictions were made by selecting studies, which included one or more cognitive measures and reported blood pressure recordings. Studies that included participants with medical conditions or people diagnosed with dementia, psychiatric disorders, stroke and head trauma were excluded. The review allows selecting fifty studies that included 107,405 participants. The results were reported considering different cognitive domains separately: global cognitive functioning, attention, processing speed, executive functions, memory and visuospatial abilities. Results: Higher blood pressure appears to influence cognitive performance in different domains in the absence of dementia and severe cardiovascular diseases, such as strokes. This relationship seems to be independent of demographic factors (gender and education), medical co-morbidity (diabetes), and psychiatric disorders (depression). Furthermore, it presents different patterns considering ageing. In the elderly, a sort of “cardiovascular paradox” is highlighted, which allows considering higher blood pressure as a protective factor for cognitive functioning. Conclusions: The results underline that higher blood pressure is associated with a higher risk of cognitive decline in people without dementia or stroke. These findings highlight the need to introduce early management of blood pressure, even in the absence of clinical hypertension, to prevent the risk of a decline of cognitive functioning typically associated with ageing.
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Min M, Shi T, Sun C, Liang M, Zhang Y, Tian S, Sun Y. The association between orthostatic hypotension and cognition and stroke: a meta-analysis of prospective cohort studies. Blood Press 2019; 29:3-12. [DOI: 10.1080/08037051.2019.1689808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Min Min
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Tingting Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Chenyu Sun
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Yun Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Shun Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
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McNicholas T, Tobin K, Carey D, O'Callaghan S, Kenny RA. Is Baseline Orthostatic Hypotension Associated With a Decline in Global Cognitive Performance at 4-Year Follow-Up? Data From TILDA (The Irish Longitudinal Study on Ageing). J Am Heart Assoc 2019; 7:e008976. [PMID: 30371298 PMCID: PMC6404900 DOI: 10.1161/jaha.118.008976] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background It is postulated that orthostatic hypotension ( OH ), a reduction in blood pressure (≥20/10 mm Hg) within 3 minutes of standing, may increase cognitive decline because of cerebral hypoperfusion. This study assesses the impact of OH on global cognition at 4-year follow-up, and the impact of age and hypertension on this association. Methods and Results Data from waves 1 and 3 of TILDA (The Irish Longitudinal Study on Ageing) were used. Baseline blood pressure response to active stand was assessed using beat-to-beat blood pressure monitoring. Two measures of OH were used-at 40 seconds ( OH 40) and 110 seconds ( OH 110). Global cognition was measured using the Montreal Cognitive Assessment. Mixed-effects Poisson regression assessed whether baseline OH was associated with a decline in global cognition at 4-year follow-up. The analysis was repeated, stratifying by age (age 50-64 years and age ≥65 years), and including an interaction between OH and hypertension. Baseline OH 110 was associated with an increased error rate in Montreal Cognitive Assessment at follow-up (incident rate ratio 1.17, P=0.028). On stratification by age, the association persists in ages 50 to 64 years (incident rate ratio 1.25, P=0.048), but not ages ≥65 years. Including an interaction with hypertension found those with co-existent OH 110 and hypertension (incident rate ratio 1.27, P=0.011), or OH 40 and hypertension (incident rate ratio 1.18, P=0.017), showed an increased error rate; however, those with isolated OH 110, OH 40, or isolated hypertension did not. Conclusions OH is associated with a decline in global cognition at 4-year follow-up, and this association is dependent on age and co-existent hypertension.
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Affiliation(s)
- Triona McNicholas
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,2 The Department of Medical Gerontology Trinity College Dublin Ireland
| | - Katy Tobin
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,4 Global Brain Health Institute School of Medicine Trinity College Dublin Ireland
| | - Daniel Carey
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland
| | - Susan O'Callaghan
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,2 The Department of Medical Gerontology Trinity College Dublin Ireland
| | - Rose Anne Kenny
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,2 The Department of Medical Gerontology Trinity College Dublin Ireland.,3 Mercer's Institute for Successful Ageing St James' Hospital Dublin Ireland
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Safarpour M, Fotouhi A, Hosseini SR, Mohamadzade M, Bijani A. Predictors of Orthostatic Hypotension in the Elderly: Results from the Amirkola Health and Ageing Project (AHAP) Study. J Tehran Heart Cent 2019; 14:165-170. [PMID: 32461756 PMCID: PMC7231680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Orthostatic hypotension (OH) in the elderly is an important health challenge that poses a significant burden. We sought to determine the prevalence and correlates of OH in an elderly population-based study. Methods: This study was conducted within the framework of the Amirkola Health and Ageing Project (AHAP) on 1,588 elderly individuals aged ≥60 years. The baseline measurement was performed from April 2011 to July 2012. The relationships between OH (dependent variable) and age, sex, diabetes, hypertension, and cognitive status (independent variables) were investigated by logistic regression. Results: The mean age of the participants was 69.37±7.42 years (men: 69.96±7.68 y, women: 68.66±7.02 y). The prevalence of OH was 10.7%: 8.4% in the male and 13.7% in the female patients. In the final model, hypertension (OR=2.4, 95% CI: 1.6-3.7), diabetes (OR=1.3, 95% CI: 1.0-1.9), age (OR=2.9, 95% CI: 1.7-4.8), and female sex (female [OR=1.6, 95% CI: 1.1-2.3]) were significantly correlated with OH. Conclusion: The prevalence of OH in our elderly subjects increased with age. Additionally, the older participants with diabetes and hypertension had a higher likelihood of having this OH.
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Affiliation(s)
- Mehdi Safarpour
- Department of Disease Prevention and Control, Health Deputy, Babol University of Medical Sciences, Babol, Iran.
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Reza Hosseini
- Department of Community Medicine, School of Medicine, Babol University of Medical Sciences, Babol, Iran.,Corresponding Author: Seyed Reza Hosseini, Professor of Community Medicine, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.47745-47176. Tel: +98 11-32190560. Fax: + 98 11-32199936. E-mail: .
| | - Masume Mohamadzade
- Department of Disease Prevention and Control, Health Deputy, Babol University of Medical Sciences, Babol, Iran.
| | - Ali Bijani
- Children’s Non-Communicable Diseases Research Center, Babol University of Medical Sciences, Babol, Iran.
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Caruso P, Signori R, Moretti R. Small vessel disease to subcortical dementia: a dynamic model, which interfaces aging, cholinergic dysregulation and the neurovascular unit. Vasc Health Risk Manag 2019; 15:259-281. [PMID: 31496716 PMCID: PMC6689673 DOI: 10.2147/vhrm.s190470] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background Small vessels have the pivotal role for the brain’s autoregulation. The arteriosclerosis-dependent alteration of the brain perfusion is one of the major determinants in small vessel disease. Endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia (sVAD). sVAD increases morbidity and disability. Epidemiological studies have shown that sVAD shares with cerebrovascular disease most of the common risk factors. The molecular basis of this pathology remains controversial. Purpose To detect the possible mechanisms between small vessel disease and sVAD, giving a broad vision on the topic, including pathological aspects, clinical and laboratory findings, metabolic process and cholinergic dysfunction. Methods We searched MEDLINE using different search terms (“vascular dementia”, “subcortical vascular dementia”, “small vessel disease”, “cholinergic afferents”, etc). Publications were selected from the past 20 years. Searches were extended to Embase, Cochrane Library, and LILIACS databases. All searches were done from January 1, 1998 up to January 31, 2018. Results A total of 560 studies showed up, and appropriate studies were included. Associations between traditional vascular risk factors have been isolated. We remarked that SVD and white matter abnormalities are seen frequently with aging and also that vascular and endothelium changes are related with age; the changes can be accelerated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors. Conclusion Small vessel disease and the related dementia are two pathologies that deserve attention for their relevance and impact in clinical practice. Hypertension might be a historical problem for SVD and SVAD, but low pressure might be even more dangerous; CBF regional selective decrease seems to be a critical factor for small vessel disease-related dementia. In those patients, endothelium damage is a super-imposed condition. Several issues are still debatable, and more research is needed.
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Affiliation(s)
- Paola Caruso
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Riccardo Signori
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Rita Moretti
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
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Chen YC, Liu YL, Tsai SJ, Kuo PH, Huang SS, Lee YS. LRRTM4 and PCSK5 Genetic Polymorphisms as Markers for Cognitive Impairment in A Hypotensive Aging Population: A Genome-Wide Association Study in Taiwan. J Clin Med 2019; 8:jcm8081124. [PMID: 31362389 PMCID: PMC6723657 DOI: 10.3390/jcm8081124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 01/19/2023] Open
Abstract
Hypotension can affect cerebral perfusion and worsen cognitive outcomes. The prevalence of low blood pressure (BP) rises with increasing age. To our knowledge, no study has examined the genetic biomarkers for hypotension-related cognitive impairment (CI) yet. Utilizing the population-based genome-wide study of the Taiwan Biobank containing the data of 2533 healthy aging subjects, we found after adjustments for age, sex, education years, and principal components at a suggestive level of 1 × 10−5 that minor alleles of leucine rich repeat transmembrane neuronal 4 (LRRTM4) (rs13388459, rs1075716, rs62171995, rs17406146, rs2077823, and rs62170897), proprotein convertase subtilisin/kexin type 5 (PCSK5) (rs10521467), and the intergenic variation rs117129097 (the nearby gene: TMEM132C) are risk factors for CI in hypotensive subjects. Except for rs117129097, these single nucleotide polymorphisms (SNPs) were not markers per se for CI or for BP regulation. However, we found a suggestive interaction effect between each of the eight SNPs and hypotension on CI risk. In the hypotensive participants, those carrying minor alleles were associated with a higher incidence of CI in an additive manner than were those carrying major alleles (2 × 10−4 to 9 × 10−7). Intensive BP lowering in elderly patients carrying a minor allele of the eight identified SNPs should raise cautions to prevent a potential treatment-induced neurodegeneration.
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Affiliation(s)
- Yi-Chun Chen
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, No.5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan
- Dementia Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan County 333, Taiwan
| | - Yu-Li Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Taipei 11217, Taiwan
- Division of Psychiatry, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan
| | - Po-Hsiu Kuo
- Department of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, No.17, Xuzhou Rd, Taipei 100, Taiwan
| | - Shih-Sin Huang
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei 11529, Taiwan
| | - Yun-Shien Lee
- Department of Biotechnology, Ming Chuan University, 5 De Ming Rd., Taoyuan City 333, Taiwan.
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan.
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Lu H, Wang XD, Shi Z, Yue W, Zhang Y, Liu S, Liu S, Zhao L, Xiang L, Zhang Y, Guan Y, Su W, Li Z, Wang J, Wisniewski T, Ji Y. Comparative analysis of cognitive impairment prevalence and its etiological subtypes in a rural area of northern China between 2010 and 2015. Sci Rep 2019; 9:851. [PMID: 30696930 PMCID: PMC6351643 DOI: 10.1038/s41598-018-37286-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/03/2018] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to evaluate changes in the prevalence and risk factors of cognitive impairment (CI) by analyzing and comparing two cross-sectional epidemiological surveys of CI and its subtypes were performed in a rural area of northern China between 2010 and 2015. Residents aged ≥60 years were drawn in northern China. The Mini Mental State Examination (MMSE) is recommended to test for CI. Dementia was further categorised into Alzheimer’s disease (AD), vascular dementia (VaD), and dementia caused by other diseases (ODs). Mild cognitive impairment (MCI) was classified into MCI caused by AD (MCI-A), MCI caused by VaD (MCI-VD), and MCI caused by ODs (MCI-O). The prevalence of CI increased in China. The prevalence of all-cause CI was 30·5% (22.9% MCI and 7.6% dementia) in 2010. The prevalence of all-cause CI was 38.3% (27.8% MCI and 10.5% dementia) in 2015. Similar increases were observed for the prevalence of subtypes of dementia and MCI. These findings suggest an increasing prevalence of CI and its subtypes in China, which may be related to alterations in sociodemographic factors, vascular risk factors and lifestyle changes over time in these cohorts.
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Affiliation(s)
- Hui Lu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiao-Dan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Ying Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuling Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Lei Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Lei Xiang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yajing Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yalin Guan
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Wenhua Su
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhiyong Li
- Tianjin Jixian County Health Bureau, Tianjin, China
| | - Jinhuan Wang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Thomas Wisniewski
- New York University School of Medicine, Department of Neurology, Psychiatry and Pathology, New York, N.Y., USA
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
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Stewart KC, Subramanian D, Neal UJ, Hanson AJ. APOE Genotype Influences Postprandial Blood Pressure after High Fat Feeding in Older Adults. J Nutr Health Aging 2019; 23:408-413. [PMID: 31021357 PMCID: PMC6544369 DOI: 10.1007/s12603-019-1167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Postprandial hypotension (PPH) is a common phenomenon among older adults. The degree to which individuals experience PPH is related to cerebrovascular risk factors and the presence of neurodegenerative diseases such as Alzheimer's disease (AD). Carrier status of the E4 allele of the apolipoprotein E (APOE) gene is a risk factor for AD and influences a variety of responses to metabolic and dietary interventions. However, it is unknown whether APOE genotype influences the risk of PPH and whether type of meal can mediate that response. DESIGN Acute meal study with a crossover design. PARTICIPANTS 32 cognitively healthy older adults with (n=18) and without (n=14) E4+ carrier status. INTERVENTION As a part of an ongoing meal study we examined the postprandial blood pressure response after ingestion of a high carbohydrate (HCM) and high fat meal (HFM). MEASUREMENTS Blood pressure measurements were taken at 7 time points and change scores, area under the curve (AUC) scores were calculated. Data were analyzed by repeated measures ANOVA as well as Pearson correlation. RESULTS Both meals produced a sustained drop in systolic (SBP) and diastolic (DBP) blood pressure, with 37.5% of participants meeting criteria for PPH. Participants carrying the E4+ risk gene experienced a larger decrease in SBP than E4- participants, and this was significantly different after the HFM (E4+ AUC = -30.8 ± 7.6, E4- AUC = -0.2 ± 8.7, p=0.015). Increasing age was associated with a larger drop in postprandial blood pressure but only for the E4+ group after the HFM (p=0.002). CONCLUSIONS These data suggest that E4+ individuals experience a greater postprandial blood pressure response particularly following high fat feeding, and this effect becomes more pronounced with age. The prevalence of PPH may play a role in the development of AD and may be mediated by diet.
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Affiliation(s)
- K C Stewart
- Angela J Hanson, MD, Assistant Professor, Geriatric Medicine, University of Washington School of Medicine, 325 9th Ave, Box 359755, Seattle, WA, USA 98104, Phone: 206-897-5393, Fax: 206-744-9976,
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He M, Wang J, Liu N, Xiao X, Geng S, Meng P, Ji N, Sun Y, Xu B, Xu Y, Zhou X, Zhang G, He X, Cai Z, Li Z, Wang B, Xu B, Hui R, Wang Y. Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment. Stroke 2018; 49:1610-1617. [PMID: 29895539 DOI: 10.1161/strokeaha.118.020827] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Blood pressure (BP) control in the early phase of stroke is controversial to reduce the risk of poststroke cognitive impairment (PSCI). This study was to investigate the impact of BP levels in the early phase of ischemic stroke and stroke subtype on PSCI. METHODS Seven hundred and ninety-six patients with acute ischemic stroke were included. Cognitive function was assessed after stroke onset using the Montreal Cognitive Assessment. Patients were divided into quintiles according to systolic BP and diastolic BP levels in the early phase. Subtype analyses were according to Trial of ORG 10172 in Acute Stroke Treatment classification (infarct cause) and Oxfordshire Community Stroke Project classification (infarct location). RESULTS After adjusting for multiple variables, the quintiles with the lowest systolic BP (Q1, 102-127 mm Hg) and with the highest systolic BP (Q5, 171-215 mm Hg) were associated with increased PSCI risk (odds ratio, 1.83; 95% confidence interval, 1.64-2.28; P=0.007 in Q1; odds ratio, 2.32; 95% confidence interval, 1.74-2.90; P<0.001 in Q5) at 3 months as compared with the middle quintile (Q3, 143-158 mm Hg). Similar association was found in diastolic BP quintiles. The analysis of cerebral infarction subtype demonstrated that both large artery atherosclerosis and total anterior circulation infarct were associated with increased risk of PSCI at 3 months after adjusting for multiple variables (large artery atherosclerosis: odds ratio, 1.42; 95% confidence interval, 1.06-1.90; P=0.031; total anterior circulation infarct: odds ratio, 1.68; 95% confidence interval, 1.32-2.15; P=0.001). CONCLUSIONS Lower or higher BP in the early phase of ischemic stroke was correlated with increased PSCI risk at 3 months. Maintaining systolic/diastolic BP in the levels of 143 to 158/93 to 102 mm Hg might be beneficial to reduce the occurrence of PSCI. Moreover, large artery atherosclerosis subtype and total anterior circulation infarct subtype were correlated with increased PSCI risk at 3 months. CLINICAL TRIAL REGISTRATION URL: https://www.chictr.org. Unique identifier: ChiCTR-TRC-14004804.
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Affiliation(s)
- Mingli He
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Jin'e Wang
- College of Medical Science, China Three Gorges University, Yichang (J.W.)
| | - Na Liu
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Xiao Xiao
- State Key Laboratory of Cardiovascular Disease, Sino-German Laboratory for Molecular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.X., R.H., Y.W.)
| | - Shan Geng
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Pin Meng
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Niu Ji
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Yong'an Sun
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Bingchao Xu
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Yingda Xu
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Xinyu Zhou
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Guanghui Zhang
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Xiaobing He
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Zenglin Cai
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Zaipo Li
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Bei Wang
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Bei Xu
- From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.)
| | - Rutai Hui
- State Key Laboratory of Cardiovascular Disease, Sino-German Laboratory for Molecular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.X., R.H., Y.W.)
| | - Yibo Wang
- State Key Laboratory of Cardiovascular Disease, Sino-German Laboratory for Molecular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.X., R.H., Y.W.).
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Betulinic acid, a natural PDE inhibitor restores hippocampal cAMP/cGMP and BDNF, improve cerebral blood flow and recover memory deficits in permanent BCCAO induced vascular dementia in rats. Eur J Pharmacol 2018; 832:56-66. [PMID: 29778746 DOI: 10.1016/j.ejphar.2018.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 01/17/2023]
Abstract
Vascular dementia (VaD) is the second most common form of senile dementia, embraces memory deficits, neuroinflammation, executive function damage, mood and behavioral changes and abnormal cerebral blood flow. The purpose of the study was to explore the therapeutic potential of betulinic acid in bilateral common carotid artery occlusion (BCCAO) induced VaD in experimental rats. VaD was induced by BCCAO in rats and betulinic acid (10 and 15 mg/kg/day po) was administered 1 week after surgery. The cerebral blood pressure of the animal was recorded before and after the treatment using Laser Doppler flow meter. Object recognition task for non-spatial, Morris water maze for spatial and locomotor activity was performed to evaluate behavioral changes in rats. At the end of the study, animals were decapitated and hippocampus was separated to perform biochemical, neuroinflammatory and second messengers cAMP/cGMP analysis. Histology was done to study the brain pathophysiology. BCCAO surgery was able to significantly impaired memory in rats as observed behavioral and biochemical parameters. Moreover, BA demonstrated a neuroprotective effect in a dose-dependent manner. BA was able to re-establish cerebral blood flow, restore behavioral parameters and showed significant improvements in the as cAMP,cGMP and BDNF levels, restrain the oxidative stress and inflammatory parameters. In histopathology, betulinic acid treated groups showed a decrease in microgliosis and less pathological abnormalities comparable to diseased rat's brain. The observed effect might be attributed to the neuroprotective potential of betulinic acid and its ability to restore cognitive impairment and hippocampal neurochemistry in VaD.
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Momtaz YA, Hamid TA, Haron SA, Bagat MF, Mohammadi F. Prevalence of hypotension and its association with cognitive function among older adults. Aging Ment Health 2018; 22:447-452. [PMID: 28060530 DOI: 10.1080/13607863.2016.1268093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates. METHODOLOGY The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted in Malaysia. The hypotension was considered as blood pressure <120/75 mm Hg, measuring by standard mercury manometer. Data analysis was performed using the SPSS Version 22.0. RESULTS The mean age of the respondents was 68.27 (SD = 5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD = 4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta = -0.11, p<.01), after adjusting for age, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis. CONCLUSION The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.
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Affiliation(s)
- Yadollah Abolfathi Momtaz
- a Iranian Research Center on Aging , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Tengku Aizan Hamid
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Sharifah Azizah Haron
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Mohamad Fazdillah Bagat
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Fatemeh Mohammadi
- c School of Nursing & Midwifery , Qazvin University of Medical Sciences , Qazvin , Iran
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Mugge L, Mansour TR, Krafcik B, Mazur T, Floyd-Bradstock T, Medhkour A. Immunological, vascular, metabolic, and autonomic changes seen with aging possible implications for poor outcomes in the elderly following decompressive hemicraniectomy for malignant MCA stroke: a critical review. J Neurosurg Sci 2018. [PMID: 29527887 DOI: 10.23736/s0390-5616.18.04207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Stroke is one of the leading causes of mortality and morbidity worldwide and requires rapid and intensive treatment to prevent adverse outcomes. Decompressive hemicraniectomy stands as the gold standard for surgical resolution of the intracranial swelling which accompanies cerebral infarction; however, the benefits of this procedure are not as well achieved in the elderly (age >65 years) compared to the younger population. EVIDENCE ACQUISITION This is a critical review performed on all available literature relating to middle cerebral artery (MCA) stroke in the elderly with emphasis on articles examining causality of adverse outcomes in this group over younger populations. Utilizing PRISMA guidelines, we initially identified 1462 articles. EVIDENCE SYNTHESIS After screening, four clear areas of physiological change associated with aging were identified and expounded upon as they relate to MCA stroke. These four areas include: immunological, autonomic, mitochondrial, and vascular changes. Elderly patients have a decreased and declining capacity to regulate the inflammation that develops postinfarction and this contributes to adverse outcomes from a neurological stand point. Additionally, aging decreases the ability of elderly patients to regulate their autonomic system resulting in aberrant blood pressures systemically post infarction. With age, the mitochondrial response to ischemia is exaggerated and causes greater local damage in elderly patients compared to younger populations. Finally, there are numerous vascular changes that occur with age including accumulation of homocysteine and atherosclerosis which together contributed to decreased structural integrity of the vasculature in the elderly and render decreased support to the recovery process post infarction. CONCLUSIONS We conclude that physiological changes inherent in the aging process serve to intensify adverse outcomes that are commonly associated with strokes in the elderly. Identification and subsequent minimization of these risk factors could allow for more effective management of elderly patients, post stroke, and promote better clinical outcomes.
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Affiliation(s)
- Luke Mugge
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Tarek R Mansour
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Brianna Krafcik
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Travis Mazur
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Tonya Floyd-Bradstock
- Interprofessional Immersive Simulation Center, University of Toledo Medical Center, Toledo, OH, USA
| | - Azedine Medhkour
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA -
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Yaneva-Sirakova T, Traykov L, Petrova J, Gruev I, Vassilev D. Screening for mild cognitive impairment in patients with cardiovascular risk factors. Neuropsychiatr Dis Treat 2017; 13:2925-2934. [PMID: 29255360 PMCID: PMC5722015 DOI: 10.2147/ndt.s144264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM Cardiovascular risk factors are also risk factors for cognitive impairment. They have cumulative effect in target organ damage. The precise correlation between cardiovascular risk factors and cognitive impairment, as well as assessing the extent to which they may affect cognitive functioning, is difficult to ascertain in everyday clinical practice. Quick, specific, and sensitive neuropsychological tests may be useful in screening for, and the prophylaxis of, target organ damage in hypertensive patients. METHODS We gathered full anamnesis, performed physical examination, laboratory screening and echocardiography. These variables were observed at office and home for all patients, For half of the patients, 24-hour ambulatory blood pressure monitoring and neuropsychological testing using Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), Geriatric Depression Scale, and the 4-instrumental activities of daily living scale were undertaken. RESULTS For a period of 2 years, 931 patients were included after applying the inclusion and exclusion criteria. The mean age was 65.90±10.00 years. Two hundred and sixty three patients (85 [32.32%] males and 178 [67.68%] females) were reevaluated after a mean follow-up period of 12 months (6-20 months). The mean results of MoCA and MMSE were significantly lower (p<0.05) in the group of patients with poorly controlled blood pressure and cardiovascular risk factors. There was mild to intermediate negative correlation between Systematic Coronary Risk Evaluation (SCORE) and the neuropsychological tests' results. CONCLUSION Cardiovascular risk factors play an important role for the development of cognitive impairment in the eastern European population because of their high frequency and interaction. The use of easily applicable neuropsychological tests in everyday clinical practice of specialties other than neurology may help in stratifying the risk for development and progression of mild cognitive impairment in this high-risk group.
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Affiliation(s)
| | | | - Julia Petrova
- Department of Neurology, Neurology Clinic, Medical University Sofia
| | - Ivan Gruev
- Cardiology Clinic, National Transport Hospital "Tsar Boris III", Sofia, Bulgaria
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Shekhar S, Liu R, Travis OK, Roman RJ, Fan F. Cerebral Autoregulation in Hypertension and Ischemic Stroke: A Mini Review. JOURNAL OF PHARMACEUTICAL SCIENCES AND EXPERIMENTAL PHARMACOLOGY 2017; 2017:21-27. [PMID: 29333537 PMCID: PMC5765762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aging and chronic hypertension are associated with dysfunction in vascular smooth muscle, endothelial cells, and neurovascular coupling. These dysfunctions induce impaired myogenic response and cerebral autoregulation, which diminish the protection of cerebral arterioles to the cerebral microcirculation from elevated pressure in hypertension. Chronic hypertension promotes cerebral focal ischemia in response to reductions in blood pressure that are often seen in sedentary elderly patients on antihypertensive therapy. Cerebral autoregulatory dysfunction evokes Blood-Brain Barrier (BBB) leakage, allowing the circulating inflammatory factors to infiltrate the brain to activate glia. The impaired cerebral autoregulation-induced inflammatory and ischemic injury could cause neuronal cell death and synaptic dysfunction which promote cognitive deficits. In this brief review, we summarize the pathogenesis and signaling mechanisms of cerebral autoregulation in hypertension and ischemic stroke-induced cognitive deficits, and discuss our new targets including 20-Hydroxyeicosatetraenoic acid (20-HETE), Gamma-Adducin (Add3) and Matrix Metalloproteinase-9 (MMP-9) that may contribute to the altered cerebral vascular function.
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Affiliation(s)
- Shashank Shekhar
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Ruen Liu
- Department of Neurosurgery, Peking University People’s Hospital, Beijing, China
| | - Olivia K Travis
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Richard J Roman
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Fan Fan
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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31
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Torres RV, Elias MF, Crichton GE, Dore GA, Davey A. Systolic orthostatic hypotension is related to lowered cognitive function: Findings from the Maine-Syracuse Longitudinal Study. J Clin Hypertens (Greenwich) 2017; 19:1357-1365. [PMID: 28929576 DOI: 10.1111/jch.13095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/04/2017] [Accepted: 07/16/2017] [Indexed: 01/10/2023]
Abstract
The aim of the present study was to examine the relationship between orthostatic changes in blood pressure (BP) and cognition, with consideration given to cardiovascular risk factors and lifestyle variables. The cross-sectional analysis included 961 community-dwelling participants of the Maine-Syracuse Longitudinal Study, for whom BP clinic measures (five sitting, five recumbent, and five standing) were obtained. Eighteen percent of participants had orthostatic hypotension (fall in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg upon standing) and 6% had orthostatic hypertension (rise in systolic BP ≥20 mm Hg). Orthostatic hypotension and hypertension defined using traditional criteria were unrelated to cognition with covariate adjustment. However, an examination of systolic and diastolic BP change independently revealed that participants with systolic orthostatic hypotension had poorer global cognition, verbal memory, and scanning and tracking scores than those with normal systolic BP change. The authors conclude that systolic orthostatic hypotension is significantly associated with reduced cognitive function.
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Affiliation(s)
- Rachael V Torres
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Merrill F Elias
- Department of Psychology, University of Maine, Orono, ME, USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
| | - Georgina E Crichton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Gregory A Dore
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Adam Davey
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE, USA
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Nitzan M, Slotki I, Shavit L. More accurate systolic blood pressure measurement is required for improved hypertension management: a perspective. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:157-163. [PMID: 28769596 PMCID: PMC5533571 DOI: 10.2147/mder.s141599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The commonly used techniques for systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurement are the auscultatory Korotkoff-based sphygmomanometry and oscillometry. The former technique is relatively accurate but is limited to a physician's office because its automatic variant is subject to noise artifacts. Consequently, the Korotkoff-based measurement overestimates the blood pressure in some patients due to white coat effect, and because it is a single measurement, it cannot properly represent the variable blood pressure. Automatic oscillometry can be used at home by the patient and is preferred even in clinics. However, the technique's accuracy is low and errors of 10-15 mmHg are common. Recently, we have developed an automatic technique for SBP measurement, based on an arm pressure cuff and a finger photoplethysmographic probe. The technique was found to be significantly more accurate than oscillometry, and comparable to the Korotkoff-based technique, the reference-standard for non-invasive blood pressure measurements. The measurement of SBP is a mainstay for the diagnosis and follow-up of hypertension, which is a major risk factor for several adverse events, mainly cardiovascular. Lowering blood pressure evidently reduces the risk, but excessive lowering can result in hypotension and consequently hypoperfusion to vital organs, since blood pressure is the driving force for blood flow. Erroneous measurement by 10 mmHg can lead to a similar unintended reduction of SBP and may adversely affect patients treated to an SBP of 120-130 mmHg. In particular, in elderly patients, unintended excessive reduction of blood pressure due to inaccurate SBP measurement can result in cerebral hypoperfusion and consequent cognitive decline. By using a more accurate technique for automatic SBP measurement (such as the photoplethysmographic-based technique), the optimal blood pressure target can be achieved with lower risk for hypotension and its adverse events.
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Affiliation(s)
- Meir Nitzan
- Department of Applied Physics/Electro-Optics, Jerusalem College of Technology
| | - Itzchak Slotki
- Department of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Linda Shavit
- Department of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
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Gabin JM, Tambs K, Saltvedt I, Sund E, Holmen J. Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study. ALZHEIMERS RESEARCH & THERAPY 2017; 9:37. [PMID: 28569205 PMCID: PMC5452294 DOI: 10.1186/s13195-017-0262-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/02/2017] [Indexed: 01/27/2023]
Abstract
Background A lot of attention has been paid to the relationship of blood pressure and dementia because epidemiological research has reported conflicting evidence. Observational data has shown that midlife hypertension is a risk factor for cognitive decline and dementia later in life, whereas there is evidence that low blood pressure is predictive in later life. The aim of the present study was to examine the association between dementia and blood pressure measured up to 27 years (mean 17.6 years) prior to ascertainment. Methods In Nord-Trøndelag County, Norway, incident dementia data were collected during 1995–2011, and the diagnoses were validated by a panel of experts in the field. By using the subjects’ personal identification numbers, the dementia data were linked to data from the Nord-Trøndelag Health Study (the HUNT Study), a large, population-based health study performed in 1984–1986 (HUNT 1) and 1995–1997 (HUNT 2). A total of 24,638 participants of the HUNT Study were included in the present study, 579 of whom were diagnosed with Alzheimer disease, mixed Alzheimer/vascular dementia, or vascular dementia. Multiple logistic regression analyses were conducted to analyze the association between dementia and blood pressure data from HUNT 1 and HUNT 2. Results Over the age of 60 years, consistent inverse associations were observed between systolic blood pressure and all-cause dementia, mixed Alzheimer/vascular dementia, and Alzheimer disease, but not with vascular dementia, when adjusting for age, sex, education, and other relevant covariates. This was observed for systolic blood pressure in both HUNT 1 and HUNT 2, regardless of antihypertensive medication use. There was an adverse association between systolic blood pressure, pulse pressure, and Alzheimer disease in individuals treated with antihypertensive medication under the age of 60 years. Conclusions Our data are in line with those in previous studies demonstrating an inverse association between dementia and systolic blood pressure in individuals over the age of 60 years. We cannot exclude a survival effect, however. Among middle-aged subjects (<60 years), elevated systolic blood pressure and pulse pressure were associated with eventual Alzheimer disease in individuals who reported using antihypertensive medication. Electronic supplementary material The online version of this article (doi:10.1186/s13195-017-0262-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessica Mira Gabin
- HUNT Research Centre, Faculty of Medicine and Health Sciences , Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Forskningsveien 2, 7600, Levanger, Norway.
| | - Kristian Tambs
- Division of Mental Health, Norwegian Institute of Public Health, Post Office Box 4404, Nydalen, 0403, Oslo, Norway
| | - Ingvild Saltvedt
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Post Office Box 8905, 7491, Trondheim, Norway.,Department of Geriatrics, St. Olav's Hospital, Post Office Box 3250, 7006, Trondheim, Norway
| | - Erik Sund
- HUNT Research Centre, Faculty of Medicine and Health Sciences , Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Forskningsveien 2, 7600, Levanger, Norway
| | - Jostein Holmen
- HUNT Research Centre, Faculty of Medicine and Health Sciences , Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Forskningsveien 2, 7600, Levanger, Norway
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Heo SH, Bushnell CD. Factors Influencing Decision Making for Carotid Endarterectomy versus Stenting in the Very Elderly. Front Neurol 2017; 8:220. [PMID: 28603515 PMCID: PMC5445117 DOI: 10.3389/fneur.2017.00220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/08/2017] [Indexed: 12/29/2022] Open
Abstract
As the population ages worldwide, the number of elderly patients with carotid stenosis is also increasing. There have been many large clinical trials comparing carotid endarterectomy (CAE) versus stenting, but the inclusion criteria (i.e., symptomatic or asymptomatic), stenting methods (i.e., protection device), and primary end point (i.e., the definition of myocardial infarction and follow-up period) were different between trials. Therefore, the interpretation of those results is difficult and requires attention. When it comes to age, the patients older than 80 years were excluded or stratified to a high risk group in previous landmark trials. However, a recent guideline recommended that endarterectomy may be associated with lower stroke risk compared with carotid artery stenting in patients older than 70 years with symptomatic carotid disease. The annual risk of stroke in individuals with asymptomatic carotid stenosis is about 1-3% but the risk is about 4-12% with symptomatic stenosis without carotid intervention. Although the outcome of CAE is better than that of carotid stenting in patients older than 70 years, the perioperative risk is higher in older patients. Therefore, it is important to classify high risk patients and consider underlying disability and life expectancy of very elderly patients before deciding whether to undergo a carotid intervention. In addition, we should also consider that the stroke rate with intensive medical treatment is unknown and is currently being investigated in randomized controlled trials. Intensive medical treatment includes high intensity statins, diabetes and blood pressure control, and aggressive antiplatelet treatment. The aim of this review is to report the factors that may be responsible for the variability in the treatment of carotid stenosis, particularly in the elderly population. This will allow the readers to integrate the current available evidence to individualize the treatment of carotid stenosis in this challenging population.
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Affiliation(s)
- Sung Hyuk Heo
- Department of Neurology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Espay AJ, LeWitt PA, Hauser RA, Merola A, Masellis M, Lang AE. Neurogenic orthostatic hypotension and supine hypertension in Parkinson's disease and related synucleinopathies: prioritisation of treatment targets. Lancet Neurol 2017; 15:954-966. [PMID: 27478953 DOI: 10.1016/s1474-4422(16)30079-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/21/2016] [Accepted: 05/12/2016] [Indexed: 12/18/2022]
Abstract
Neurogenic orthostatic hypotension and supine hypertension are common manifestations of cardiovascular dysautonomia in Parkinson's disease and related synucleinopathies. Because these disorders are haemodynamic opposites, improvement in one might be achieved at the expense of worsening of the other. Thus, management decisions necessitate assessment of the individual risks for patients with coexistent neurogenic orthostatic hypotension and supine hypertension. Whereas neurogenic orthostatic hypotension poses risks for falls and can be associated with cognitive impairment in the short term, chronic supine hypertension can be associated with stroke and myocardial infarction in the long term. Because few clinical trial data exist for outcomes in patients with coexistent neurogenic orthostatic hypotension and supine hypertension, clinicians need to balance, on the basis of comorbidities and disease staging, the potential immediate benefits of treatment for neurogenic orthostatic hypotension and the long-term risks of supine hypertension treatment in each patient. Future research needs to focus on ascertaining a safe degree of supine hypertension when treating neurogenic orthostatic hypotension; the effectiveness of nocturnal antihypertensive therapy in patients with coexistent neurogenic orthostatic hypotension and supine hypertension; and the prevalence, scope, and therapeutic requirements for managing neurogenic orthostatic hypotension that manifests with falls or cognitive impairment, but without postural lightheadedness or near syncope.
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Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Peter A LeWitt
- Parkinson's Disease and Movement Disorders Program, Henry Ford Hospital, West Bloomfield, MI, USA; Department of Neurology, Wayne State University School of Medicine, West Bloomfield, MI, USA
| | - Robert A Hauser
- USF Health Byrd NPF Parkinson's Disease and Movement Disorders Center of Excellence, Tampa, FL, USA
| | - Aristide Merola
- Department of Neuroscience, University of Torino, Torino, Italy
| | - Mario Masellis
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Anthony E Lang
- Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, ON, Canada
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Holm H, Nägga K, Nilsson ED, Melander O, Minthon L, Bachus E, Fedorowski A, Magnusson M. Longitudinal and postural changes of blood pressure predict dementia: the Malmö Preventive Project. Eur J Epidemiol 2017; 32:327-336. [PMID: 28190139 PMCID: PMC5437180 DOI: 10.1007/s10654-017-0228-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/24/2017] [Indexed: 12/17/2022]
Abstract
The role of blood pressure (BP) changes in dementia is debatable. We aimed to analyse how resting and postural BP changes relate to incident dementia over a long-term follow-up. In the prospective population-based Malmö Preventive Project, 18,240 study participants (mean age: 45 ± 7 years, 63% male) were examined between 1974 and 1992 with resting and standing BP measurement, and re-examined between 2002 and 2006 at mean age of 68 ± 6 years with resting BP. A total of 428 participants (2.3%) were diagnosed with dementia through Dec 31, 2009. The association of resting and postural BP changes with risk of dementia was studied using multivariable-adjusted Cox regression models controlling for traditional risk factors. Diastolic BP (DBP) decrease on standing indicated higher risk of dementia [Hazard ratio (HR) per 10 mmHg: 1.22; 95% confidence interval (CI) 1.01-1.44, p = 0.036], which was mainly driven by increased risk in normotensive individuals. Higher systolic (SBP) and diastolic BP at re-examination was associated with lower risk of dementia (HR per 10 mmHg: 0.94; 95% CI 0.89-0.99, p = 0.011; and 0.87; 0.78-0.96, p = 0.006, respectively). Extreme decrease in SBP/DBP between baseline and re-examination (4th quartile; -7 ± 12/-15 ± 7 mmHg, respectively) indicated higher risk of dementia (HR 1.46; 95% CI 1.11-1.93, p = 0.008, and 1.54; 95% CI 1.14-2.08, p = 0.005; respectively) compared with reference group characterised by pronounced BP increase over the same period (1st quartile; +44 ± 13/+15 ± 7 mmHg). Diastolic BP decrease on standing in the middle age, decline in BP between middle-and advanced age, and lower BP in advanced age are independent risk factors of developing dementia.
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Affiliation(s)
- Hannes Holm
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden.
- Department of Internal Medicine, Skåne University Hospital, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Erik D Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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Kamchatnov PR, Chugunov AV, Tyazhelnikov AA, Pyshkina LI. Pathogenesis of chronic disorders of cerebral circulation. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:70-77. [DOI: 10.17116/jnevro201711712270-77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Curreri C, Giantin V, Veronese N, Trevisan C, Sartori L, Musacchio E, Zambon S, Maggi S, Perissinotto E, Corti MC, Crepaldi G, Manzato E, Sergi G. Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly. Hypertension 2016; 68:427-35. [DOI: 10.1161/hypertensionaha.116.07334] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/25/2016] [Indexed: 11/16/2022]
Abstract
We studied a cohort of 1408 older subjects to explore whether postural changes in blood pressure (BP; defined as orthostatic hypo- or hypertension) can predict the onset of cognitive deterioration. Orthostatic hypotension was defined as a drop of 20 mm Hg in systolic or 10 mm Hg in diastolic BP and orthostatic hypertension as a rise of 20 mm Hg in systolic BP. Orthostatic BP values were grouped into quintiles for secondary analyses. Two cognitive assessments were considered: (1) cognitive impairment, that is, Mini-Mental State Examination scores ≤24/30, and (2) cognitive decline (CD), that is, a 3-point decrease in Mini-Mental State Examination score from the baseline to the follow-up. At the baseline, the prevalence of orthostatic hypotension and hypertension was 18.3% and 10.9%, respectively. At the follow-up (4.4±1.2 years), 286 participants were found cognitively impaired and 138 had a CD. Using logistic regression analysis adjusted for potential baseline confounders, participants with orthostatic hypertension were at significantly higher risk of CD (odds ratio =1.50; 95% confidence intervals =1.26–1.78). Neither orthostatic hypotension nor orthostatic hypertension raised the risk of developing a cognitive impairment. Using quintiles of orthostatic BP values, we found that both decreases and increases in systolic and diastolic BP raised the risk of CD, but not of cognitive impairment. In conclusion, we found that orthostatic hypertension predicts the onset of CD, but not of cognitive impairment in the elderly, whereas orthostatic hypotension predicts neither of these conditions. Further studies are needed to confirm our findings.
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Affiliation(s)
- Chiara Curreri
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Valter Giantin
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Nicola Veronese
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Caterina Trevisan
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Leonardo Sartori
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Estella Musacchio
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Sabina Zambon
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Stefania Maggi
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Egle Perissinotto
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Maria Chiara Corti
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Gaetano Crepaldi
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Enzo Manzato
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
| | - Giuseppe Sergi
- From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato)
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Emdin CA, Rothwell PM, Salimi-Khorshidi G, Kiran A, Conrad N, Callender T, Mehta Z, Pendlebury ST, Anderson SG, Mohseni H, Woodward M, Rahimi K. Blood Pressure and Risk of Vascular Dementia: Evidence From a Primary Care Registry and a Cohort Study of Transient Ischemic Attack and Stroke. Stroke 2016; 47:1429-35. [PMID: 27165956 DOI: 10.1161/strokeaha.116.012658] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Vascular dementia is the second most common form of dementia but reliable evidence on age-specific associations between blood pressure (BP) and risk of vascular dementia is limited and some studies have reported negative associations at older ages. METHODS In a cohort of 4.28 million individuals, free of known vascular disease and dementia and identified from linked electronic primary care health records in the United Kingdom (Clinical Practice Research Datalink), we related BP to time to physician-diagnosed vascular dementia. We further determined associations between BP and dementia in a prospective population-based cohort of incident transient ischemic attack and stroke (Oxford Vascular Study). RESULTS For a median follow-up of 7.0 years, 11 114 initial presentations of vascular dementia were observed in the primary care cohort after exclusion of the first 4 years of follow-up. The association between usual systolic BP and risk of vascular dementia decreased with age (hazard ratio per 20 mm Hg higher systolic BP, 1.62; 95% confidence interval, 1.13-2.35 at 30-50 years; 1.26, 1.18-1.35 at 51-70 years; 0.97, 0.92-1.03 at 71-90 years; P trend=0.006). Usual systolic BP remained predictive of vascular dementia after accounting for effect mediation by stroke and transient ischemic attack. In the population-based cohort, prior systolic BP was predictive of 5-year risk of dementia with no evidence of negative association at older ages. CONCLUSIONS BP is positively associated with risk of vascular dementia, irrespective of preceding transient ischemic attack or stroke. Previous reports of inverse associations in old age could not be confirmed.
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Affiliation(s)
- Connor A Emdin
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Peter M Rothwell
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Gholamreza Salimi-Khorshidi
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Amit Kiran
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Nathalie Conrad
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Thomas Callender
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Ziyah Mehta
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Sarah T Pendlebury
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Simon G Anderson
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Hamid Mohseni
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Mark Woodward
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Kazem Rahimi
- From the George Institute for Global Health (C.A.E., G.S.-K., A.K., N.C., T.C., S.G.A., H.M., M.W., K.R.), Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (P.M.R., Z.M., S.T.P.), and Division of Cardiovascular Medicine, Radcliffe Department of Medicine (K.R.), University of Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Australia (M.W.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.).
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Neurocardiovascular Instability and Cognition. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2016; 89:59-71. [PMID: 27505017 PMCID: PMC4797838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neurocardiovascular instability (NCVI) refers to abnormal neural control of the cardiovascular system affecting blood pressure and heart rate behavior. Autonomic dysfunction and impaired cerebral autoregulation in aging contribute to this phenomenon characterized by hypotension and bradyarrhythmia. Ultimately, this increases the risk of falls and syncope in older people. NCVI is common in patients with neurodegenerative disorders including dementia. This review discusses the various syndromes that characterize NCVI icluding hypotension, carotid sinus hypersensitivity, postprandial hypotension and vasovagal syncope and how they may contribute to the aetiology of cognitive decline. Conversely, they may also be a consequence of a common neurodegenerative process. Regardless, recognition of their association is paramount in optimizing management of these patients.
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Bassi A, Bozzali M. Potential Interactions between the Autonomic Nervous System and Higher Level Functions in Neurological and Neuropsychiatric Conditions. Front Neurol 2015; 6:182. [PMID: 26388831 PMCID: PMC4559639 DOI: 10.3389/fneur.2015.00182] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/10/2015] [Indexed: 11/17/2022] Open
Abstract
The autonomic nervous system (ANS) maintains the internal homeostasis by continuously interacting with other brain structures. Its failure is commonly observed in many neurological and neuropsychiatric disorders, including neurodegenerative and vascular brain diseases, spinal cord injury, and peripheral neuropathies. Despite the different underlying pathophysiological mechanisms, ANS failure associates with various forms of higher level dysfunctions, and may also negatively impact on patients’ clinical outcome. In this review, we will discuss potential relationships between ANS and higher level dysfunctions in a selection of neurological and neuropsychiatric disorders. In particular, we will focus on the effect of a documented fall in blood pressure fulfilling the criteria for orthostatic hypotension and/or autonomic-reflex impairment on cognitive performances. Some evidence supports the hypothesis that cardiovascular autonomic failure may play a negative prognostic role in most neurological disorders. Despite a clear causal relationship between ANS involvement and higher level dysfunctions that is still controversial, this might have implications for neuro-rehabilitation strategies aimed at improving patients’ clinical outcome.
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Affiliation(s)
- Andrea Bassi
- Clinical and Behavioural Neurology Laboratory, IRCCS Santa Lucia Foundation , Rome , Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation , Rome , Italy
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Kokubo Y, Iwashima Y. Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease. Hypertension 2015; 66:254-9. [PMID: 26077565 DOI: 10.1161/hypertensionaha.115.03480] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 05/25/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Yoshihiro Kokubo
- From the Department of Preventive Cardiology (Y.K.) and Division of Hypertension and Nephrology, Department of Medicine (Y.I.), National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yoshio Iwashima
- From the Department of Preventive Cardiology (Y.K.) and Division of Hypertension and Nephrology, Department of Medicine (Y.I.), National Cerebral and Cardiovascular Center, Suita, Japan
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Jellinger KA. Pathogenesis and treatment of vascular cognitive impairment. Neurodegener Dis Manag 2014; 4:471-90. [DOI: 10.2217/nmt.14.37] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
SUMMARY Vascular cognitive impairment (VCI) defines a continuum of disorders ranging from mild cognitive impairment to full-blown dementia, attributable to cerebrovascular causes. Major morphological types – multi-infarct encephalopathy, strategic infarct type, subcortical arteriosclerotic leukoencephalopathy, multilacunar state, postischemic encephalopathy – result from systemic, cardiac and local large or small vessel disease. Cognitive decline is commonly caused by widespread small cerebrovascular lesions (CVLs) affecting regions/networks essential for cognition, memory and behavior. CVLs often coexist with Alzheimer-type and other pathologies, which interact in promoting dementia, but in many nondemented elderly individuals, mixed brain pathologies are also present. Due to the high variability of CVLs, no validated clinical and neuropathological criteria for VCI are available. Cholinesterase inhibitors and memantine produce small cognitive improvement but without essential effect. Antihypertensive treatment, cardiovascular control and lifestyle modifications reducing vascular risk factors are essential. Given its growing health, social and economic burden, prevention and treatment of VCI are a major challenge of neuroscience.
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Elmståhl S, Widerström E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skåne. Clin Interv Aging 2014; 9:1993-2002. [PMID: 25429211 PMCID: PMC4242065 DOI: 10.2147/cia.s72316] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Contradictory results have been reported on the relationship between orthostatic hypotension (OH) and mild cognitive impairment (MCI). OBJECTIVE To study the incidence of MCI and dementia and their relationship to OH and subclinical OH with orthostatic symptoms (orthostatic intolerance). STUDY DESIGN AND SETTING This study used a prospective general population cohort design and was based on data from the Swedish Good Aging in Skåne study (GÅS-SNAC), they were studied 6 years after baseline of the present study, with the same study protocol at baseline and at follow-up. The study sample comprised 1,480 randomly invited subjects aged 60 to 93 years, and had a participation rate of 82% at follow-up. OH test included assessment of blood pressure and symptoms of OH. RESULTS The 6-year incidence of MCI was 8%, increasing from 12.1 to 40.5 per 1,000 person-years for men and 6.9 to 16.9 per 1,000 person-years for women aged 60 to >80 years. The corresponding 6-year incidence of dementia was 8%. Orthostatic intolerance during uprising was related to risk for MCI at follow-up (odds ratio [OR] =1.84 [1.20-2.80][95% CI]), adjusted for age and education independently of blood pressure during testing. After stratification for hypertension (HT), the corresponding age-adjusted OR for MCI in the non-HT group was 1.71 (1.10-2.31) and 1.76 (1.11-2.13) in the HT group. Among controls, the proportion of those with OH was 16%; those with MCI 24%; and those with dementia 31% (age-adjusted OR 1.93 [1.19-3.14]). CONCLUSION Not only OH, but also symptoms of OH, seem to be a risk factor for cognitive decline and should be considered in the management of blood pressure among the elderly population.
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Affiliation(s)
- Sölve Elmståhl
- Division of Geriatric Medicine, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Elisabet Widerström
- Division of Geriatric Medicine, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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45
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Increased pulse pressure linked to dementia: further results from the Hypertension in the Very Elderly Trial - HYVET. J Hypertens 2014; 31:1868-75. [PMID: 23743809 DOI: 10.1097/hjh.0b013e3283622cc6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High blood pressure (BP) has been associated with increased risk of dementia. Concerns have been raised about lowering BP too far in the very elderly and thereby increasing risk. There is some evidence to suggest a potential 'J'-shaped relationship between DBP and risk of cognitive impairment. This was investigated using data from the HYpertension in the Very Elderly Trial (HYVET). METHODS HYVET was a double-blind, placebo-controlled trial of antihypertensives in patients aged at least 80 years with an untreated SBP of 160-199 mmHg. Active medication was indapamide sustained release 1.5 mg+/- perindopril 2-4 mg to reach goal pressure of less than 150/80 mmHg. Incident dementia was a secondary endpoint and was not significantly different between the two treatment groups. The relationship between pressure and incident dementia was assessed using Cox proportional hazards regression with BP entered as either a discrete (quartile analysis) or continuous predictor variable. Achieved BP was calculated as the mean of all pressures from the 9 month visit onwards. RESULTS During a mean follow-up of 2.2 years 263 incident cases of dementia were diagnosed. After adjustment for various covariates, baseline DBP was inversely related to incident dementia (P=0.0064). Achieved DBP did not predict later dementia in the placebo group (P=0.43), but showed a U-shaped relationship in the active treatment group (P=0.0195). The relationship between incident dementia and DBP did however not differ significantly between the placebo and active treatment groups (P=0.38). SBP was not associated with incident dementia, at baseline (P=0.62) or during follow-up (placebo group P=0.13, active group P=0.36). Wider achieved pulse pressure (PP) was associated with increased risk of dementia in both treatment groups (placebo P=0.032, active P=0.0046). The same tendency was observed for baseline PP (P=0.095). CONCLUSION Wider PP may possibly indicate an increased risk for dementia. Active treatment may act to change the shape of the relationship between DBP and dementia. Future studies need to focus on exploring the ideal goal pressure for this age group.
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Sain M, Kovacic V, Radic J, Ljutic D, Jelicic I. What are the lowest doses of low molecular weight heparin for effective and safe hemodialysis in different subgroups of patients? Ther Apher Dial 2014; 18:208-9. [PMID: 24720413 DOI: 10.1111/1744-9987.12108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Milenka Sain
- Department of Nephrology and Dialysis, University Hospital Center Split, Split, Croatia.
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Orthostatic hypotension and cognitive impairment: a dangerous association? Neurol Sci 2014; 35:951-7. [DOI: 10.1007/s10072-014-1686-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/12/2014] [Indexed: 11/29/2022]
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Gao Y, Lin Y, Sun K, Wang Y, Chen J, Wang H, Zhou X, Fan X, Hui R. Orthostatic Blood Pressure Dysregulation and Polymorphisms of β-Adrenergic Receptor Genes in Hypertensive Patients. J Clin Hypertens (Greenwich) 2014; 16:207-13. [PMID: 24552127 DOI: 10.1111/jch.12272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/18/2013] [Accepted: 12/28/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ying Gao
- State Key Laboratory of Cardiovascular Disease; Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Yahui Lin
- State Key Laboratory of Cardiovascular Disease; Sino-German Laboratory for Molecular Medicine; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Kai Sun
- State Key Laboratory of Cardiovascular Disease; Sino-German Laboratory for Molecular Medicine; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Yibo Wang
- State Key Laboratory of Cardiovascular Disease; Sino-German Laboratory for Molecular Medicine; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Jingzhou Chen
- State Key Laboratory of Cardiovascular Disease; Sino-German Laboratory for Molecular Medicine; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Hu Wang
- State Key Laboratory of Cardiovascular Disease; Sino-German Laboratory for Molecular Medicine; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Xianliang Zhou
- State Key Laboratory of Cardiovascular Disease; Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease; Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
| | - Rutai Hui
- State Key Laboratory of Cardiovascular Disease; Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
- State Key Laboratory of Cardiovascular Disease; Sino-German Laboratory for Molecular Medicine; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College; Beijing China
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49
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The evidence for treating hypertension in older people with dementia: a systematic review. J Hum Hypertens 2013; 28:283-7. [PMID: 24196416 DOI: 10.1038/jhh.2013.107] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/22/2013] [Accepted: 09/18/2013] [Indexed: 01/18/2023]
Abstract
Hypertension and dementia commonly co-exist in older people, yet guidance is lacking on how to manage these co-existing conditions. The aim of this systematic review was to assess the evidence for the treatment of hypertension in older people with dementia. Medline, EMBASE, Cochrane Library and the national research register archives were searched. Inclusion criteria were: randomised controlled trial of hypertension treatment, included participants aged 65+ years, participants had a diagnosis of dementia (global cognitive decline for at least 6 months affecting daily function), and the study assessed cognitive outcomes using validated tools. Dementia prevention studies and poor quality studies were excluded. The initial search revealed 1178 papers of potential interest, of which 24 were selected for review and six met the full inclusion criteria. Trials included people with mild-to-moderate but not severe dementia; exclusion criteria for the trials were extensive. Four trials were placebo-controlled RCTs; the remaining two compared different antihypertensives. All trials reported MMSE scores at baseline and follow-up; four reported blood pressure changes at follow-up; and only three reported cardiovascular morbidity or mortality at follow-up. Only one of four placebo-controlled studies showed evidence of blood pressure reduction, but no clear evidence for benefit (or harm) from antihypertensives on cognition, physical function or other cardiovascular outcomes. We found no evidence to confirm or refute the hypothesis that treatment of hypertension in people with dementia leads to overall health benefit.
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Son JT, Lee E. Comparison of postprandial blood pressure reduction in the elderly by different body position. Geriatr Nurs 2013; 34:282-8. [DOI: 10.1016/j.gerinurse.2013.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 03/08/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
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