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Gibson M, Yiallourou S, Pase MP. The Association Between 24-Hour Blood Pressure Profiles and Dementia. J Alzheimers Dis 2023; 94:1303-1322. [PMID: 37458039 DOI: 10.3233/jad-230400] [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] [Indexed: 07/18/2023]
Abstract
Midlife hypertension increases risk for dementia. Around one third of adults have diagnosed hypertension; however, many adults are undiagnosed, or remain hypertensive despite diagnosis or treatment. Since blood pressure (BP) follows a circadian rhythm, ambulatory BP monitoring allows for the assessment of BP over a 24-hour period and provides an important tool for improving the diagnosis and management of hypertension. The measurement of 24-hour BP profiles, especially nocturnal BP, demonstrate better predictive ability for cardiovascular disease and mortality than office measurement. However, few studies have examined 24-hour BP profiles with respect to dementia risk. This is an important topic since improvements in BP management could facilitate the primary prevention of vascular cognitive impairment and dementia. Therefore, this review discusses the evidence linking BP to dementia, with a focus on whether the implementation of 24-hour BP measurements can improve risk prediction and prevention strategies. Pathways linking nocturnal BP to dementia are also discussed as are risk reduction strategies. Overall, limited research suggests an association between 24-hour BP elevation and poorer cognition, cerebral small vessel disease, and dementia. However, most studies were cross-sectional. Further evidence is needed to substantiate 24-hour BP profiles, over and above office BP, as predictors of vascular cognitive impairment and incident dementia.
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Affiliation(s)
- Madeline Gibson
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Stephanie Yiallourou
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Matthew P Pase
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Juengst S, Supnet C, Kew CLN, Silva V, Vega M, Han G, Kelley B, Smith ML, Maestre G. Bilingual problem-solving training for caregivers of adults with dementia: A randomized, factorial-design protocol for the CaDeS trial. Contemp Clin Trials 2021; 108:106506. [PMID: 34273551 PMCID: PMC8453060 DOI: 10.1016/j.cct.2021.106506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Caregivers of individuals with Alzheimer's disease and related dementias (ADRD) often experience debilitating caregiver burden and emotional distress. To address these negative emotional consequences of caregiving, we will test and refine a strategy training intervention - Problem-Solving Training (PST) - that promotes self-efficacy and reduces caregiver burden and depressive symptoms. Previous research supports efficacy of PST; however, we do not know exactly how many PST sessions are needed or if post-training "boosters" are required to maintain PST benefits. Additionally, we translated and culturally-adapted PST into "Descubriendo Soluciones Juntos" (DSJ), our novel intervention for Spanish-speaking caregivers. METHOD In this 2 × 2 factorial design randomized controlled trial, we will test remotely-delivered PST/DSJ sessions for both English- and Spanish-speaking caregivers of persons with ADRD to determine the optimal number of PST/DSJ sessions and ongoing "booster" sessions needed to best help caregivers navigate their current and future needs. AIMS 1) Compare the efficacy of three vs. six PST/DSJ sessions each with and without booster sessions for decreasing caregiver burden and depression and enhancing caregiver problem-solving; 2) Identify key factors associated with efficacy of PST/DSJ, including age, gender, primary language, relationship to care recipient, and uptake of the PST/DSJ strategy. RESULTS These results will establish guidelines needed for an evidence-based, culturally-adapted, and implementable problem-solving intervention to reduce caregiver stress and burden and improve caregiver health and well-being. CONCLUSION This work promotes inclusion of diverse and underserved populations and advances therapeutic behavioral interventions that improve the lives of caregivers of individuals with chronic conditions.
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Affiliation(s)
- ShannonB Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Applied Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America.
| | - Charlene Supnet
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Chung Lin Novelle Kew
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Applied Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Valeria Silva
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Marlene Vega
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America; Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America
| | - Brendan Kelley
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America
| | - Gladys Maestre
- School of Medicine, University of Texas Rio Grande Valley, One West University Boulevard, Brownsville, TX 78520, United States of America
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