Hypertension and High Blood Pressure Are Associated With Dementia Among Chinese Dwelling Elderly: The Shanghai Aging Study

Significance of plasma p-tau217 in predicting long-term dementia risk in older community residents: Insights from machine learning approaches

INTRODUCTION

Whether plasma biomarkers play roles in predicting incident dementia among the general population is worth exploring.

METHODS

A total of 1857 baseline dementia-free older adults with follow-ups up to 13.5 years were included from a community-based cohort. The Recursive Feature Elimination (RFE) algorithm aided in feature selection from 90 candidate predictors to construct logistic regression, naive Bayes, bagged trees, and random forest models. Area under the curve (AUC) was used to assess the model performance for predicting incident dementia.

RESULTS

During the follow-up of 12,716 person-years, 207 participants developed dementia. Four predictive models, incorporated plasma p-tau217, age, and scores of MMSE, STICK, and AVLT, exhibited AUCs ranging from 0.79 to 0.96 in testing datasets. These models maintained robustness across various subgroups and sensitivity analyses.

DISCUSSION

Plasma p-tau217 outperforms most traditional variables and may be used to preliminarily screen older individuals at high risk of dementia.

HIGHLIGHTS

Plasma p-tau217 showed comparable importance with age and cognitive tests in predicting incident dementia among community older adults. Machine learning models combining plasma p-tau217, age, and cognitive tests exhibited excellent performance in predicting incident dementia. The training models demonstrated robustness in subgroup and sensitivity analysis.

Prevalence of cognitive impairment and its associated factors in middle-aged and elderly people in Anhui Province, China: An observational study

To understand the prevalence of cognitive impairment (CI) in middle-aged and elderly individuals in Anhui Province and to develop a CI risk prediction model. From May to June 2022, a multistage, stratified cluster-sampling method was used to select 3200 middle-aged and elderly people over 45 years old in Anhui Province for a questionnaire survey, and the Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. SPSS 25.0 was used for univariate and multivariate analyses, and R software was used to establish and validate the nomogram. A total of 3059 valid questionnaires were included, of which 384 were from participants who were diagnosed with CI, and the prevalence rate was 12.6%. Multivariate logistic analysis showed that female sex, advanced age, family history, etc., were closely related to the occurrence of CI. The area under curve (AUC) values in the modeling and validation groups were 0.845 (95% CI: 0.822-0.868) and 0.868 (95% CI: 0.835-0.902), respectively, indicating that the predictive ability of the model was good. The Hosmer-Lemeshow test suggested that the model had good goodness-of-fit, and the decision-curve evaluation nomogram had a high benefit within the threshold, which had a certain clinical importance. The prevalence rate of CI among middle-aged and elderly individuals in Anhui Province was 12.6%. Female sex, elderly age, family history, low educational status, current smoking status, sleep disorders, hypertension, stroke, and diabetes were shown to be risk factors for CI, while exercise was shown to be a protective factor.

Effect of the duration of hypertension on white matter structure and its link with cognition

The relation between hypertension (HTN) and cognition has been reported inclusive results, which may be affected by disease duration. Our study aimed to examine the influence of HTN duration on cognition and its underlying white matter (WM) changes including macrostructural WM hyperintensities (WMH) and microstructural WM integrity. A total of 1218 patients aged ≥55 years with neuropsychological assessment and a subgroup of 233 people with imaging data were recruited and divided into 3 groups (short duration: <5 years, medium duration: 5-20 years, long duration: >20 years). We found that greater HTN duration was preferentially related to worse executive function (EF), processing speed (PS), and more severe WMH, which became more significant during long duration stage. The reductions in WM integrity were evident at the early stage especially in long-range association fibers and then scattered through the whole brain. Increasing WMH and decreasing integrity of specific tracts consistently undermined EF. Furthermore, free water imaging method greatly enhanced the sensitivity in detecting HTN-related WM alterations. These findings supported that the neurological damaging effects of HTN is cumulative and neuroimaging markers of WM at macro- and microstructural level underlie the progressive effect of HTN on cognition.

Age-Dependent Changes in the Relationships between Traits Associated with the Pathogenesis of Stress-Sensitive Hypertension in ISIAH Rats

Hypertension is one of the most significant risk factors for many cardiovascular diseases. At different stages of hypertension development, various pathophysiological processes can play a key role in the manifestation of the hypertensive phenotype and of comorbid conditions. Accordingly, it is thought that when diagnosing and choosing a strategy for treating hypertension, it is necessary to take into account age, the stage of disorder development, comorbidities, and effects of emotional-psychosocial factors. Nonetheless, such an approach to choosing a treatment strategy is hampered by incomplete knowledge about details of age-related associations between the numerous features that may contribute to the manifestation of the hypertensive phenotype. Here, we used two groups of male F₂(ISIAHxWAG) hybrids of different ages, obtained by crossing hypertensive ISIAH rats (simulating stress-sensitive arterial hypertension) and normotensive WAG rats. By principal component analysis, the relationships among 21 morphological, physiological, and behavioral traits were examined. It was shown that the development of stress-sensitive hypertension in ISIAH rats is accompanied not only by an age-dependent (FDR < 5%) persistent increase in basal blood pressure but also by a decrease in the response to stress and by an increase in anxiety. The plasma corticosterone concentration at rest and its increase during short-term restraint stress in a group of young rats did not have a straightforward relationship with the other analyzed traits. Nonetheless, in older animals, such associations were found. Thus, the study revealed age-dependent relationships between the key features that determine hypertension manifestation in ISIAH rats. Our results may be useful for designing therapeutic strategies against stress-sensitive hypertension, taking into account the patients' age.

Association of subjective memory complaints amid patients of Diabetes Mellitus Type II and Hypertension

Background and Objective

Subjective memory complaints (SMCs) are suggested to predict dementia at a very early stage. However, association of SMCs with known risk factors of dementia namely diabetes mellitus Type-2 diabetes and hypertension (HTN) remain unexplored which is the main aim of this study. The objective of the study was to investigate the association of SMC with diabetes mellitus type 2 (DM2) and hypertension (HTN).

Methods

The associations of diabetes and hypertension, with SMCs has been tested in 500 participants from a tertiary care hospital of Karachi during 2017. Diagnosed cases of diabetes and hypertension were included through convenient sampling. Healthy attendants of patients were interviewed for the reference group. SMCs were assessed through a 14-item SMC questionnaire.

Results

Sample included 114 patients with only diabetes and hypertension each, 103 with both diabetes and hypertension and 169 healthy participants. Compared to healthy adults, persons with diabetes and hypertension had higher SMCs (difference, 0.88, 95% CI: 0.22, 1.54) (difference, 1.06, 95% CI: 0.40, 1.71) respectively, in fully adjusted models.

Conclusions

Compared to healthy adults of working age-group, persons with diabetes and hypertension were more likely to have SMCs. Assessment and early detection of SMCs in persons with diabetes and hypertension might be informative to provide a window for effective interventions to maintain cognitive health.

Hypothetical blood-pressure-lowering interventions and risk of stroke and dementia

We aimed to study the effects of hypothetical interventions on systolic blood pressure (SBP) and smoking on risk of stroke and dementia using data from 15 years of follow-up in the Rotterdam Study. We used data from 4930 individuals, aged 55-80 years, with no prior history of stroke, dementia or cognitive impairment, followed for 15 years within the Rotterdam Study, a population-based cohort. We defined the following sustained interventions on SBP: (1) maintaining SBP below 120 mmHg, (2) maintaining SBP below 140 mmHg, (3) reducing SBP by 10% if above 140 mmHg, (4) reducing SBP by 20% if above 140 mmHg, and a combined intervention of quitting smoking with each of these SBP-lowering strategies. We considered incident stroke and incident dementia diagnoses as outcomes. We applied the parametric g-formula to adjust for baseline and time-varying confounding. The observed 15-year risk for stroke was 10.7%. Compared to no specified intervention (i.e., the "natural course"), all interventions that involved reducing SBP were associated with a stroke risk reduction of about 10% (e.g., reducing SBP by 20% if above 140 mmHg risk ratio: 0.89; 95% CI 0.76, 1). Jointly intervening on SBP and smoking status further decreased the risk of stroke (e.g., risk ratio: 0.83; 95% CI 0.71, 0.94). None of the specified interventions were associated with a substantive change in dementia risk. Our study suggests that a joint intervention on SBP and smoking cessation during later life may reduce stroke risk, while the potential for reducing dementia risk were not observed.

Later-Onset Hypertension Is Associated With Higher Risk of Dementia in Mild Cognitive Impairment

To investigate the correlation between hypertension development and the progression of mild cognitive impairment (MCI) to dementia in middle-aged and elderly people. A population-based longitudinal cognition survey of people aged 55+ was conducted. The hypertension onset age was estimated by self-reported information and medical insurance card records. To study the effect of later-onset hypertension on dementia, the incidence of dementia was compared between the two groups. Of 277 hypertensive MCI participants without dementia, 56 (20.22%) progressed to dementia (MCIp) over the 6-year follow-up. The proportion of MCIp participants in the old-age-onset hypertension group (≥65 years) was higher than that in the middle-age-onset hypertension group (27.0 vs. 15.4%, respectively; X 2 = 5.538, P = 0.019). In the old-age-onset hypertension group, the proportion of MCIp without diabetes mellitus was higher than those with diabetes mellitus (24.7 vs. 12.6%, respectively; X 2 = 5.321, P = 0.021) and those with increased pulse pressure was higher than those without increased pulse pressure (33.3 vs. 15.4%, respectively; X 2 = 3.902, P = 0.048). However, the cox proportional hazard showed that older age was the only risk factor for MCIp (HR = 0.618, p = 0.000). These results suggest that individuals with later-onset hypertension may have greater cognition decline, even with blood pressure maintained at 130/80 mmHg with antihypertensive management.

The Longitudinal Association Between Cardiovascular Risk and Cognitive Function in Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

Objective: China has the largest population living with dementia, causing a tremendous burden on the aging society. Cardiovascular disease (CVD) may trigger a cascade of pathologies associated with cognitive aging. We aim to investigate the association between cardiovascular risk (CVR) factors and cognitive function in the nationally representative cohort in China. Methods: Participants were recruited from 150 counties in 28 provinces via a four-stage sampling method. The outcomes included several cognitive tasks. The independent variable was a composite score of cardiovascular risk calculated from sex-specific equations. We fitted the time-lagged regression to model the association between CVR and cognition. Besides, we performed cross-group analyses to test for model invariance across sex and age. We thus constrained path coefficients to be equal across each grouping variable (e.g., sex) and compared the fit of this constrained model with an unconstrained model in which the path coefficients were allowed to vary by group. Results: A total of 3,799 participants were included in the final analyses. We found that the CVR had a negative linear association with global cognition (β = -0.1, p < 0.01). Additionally, CVR had inverse linear associations with domain-specific measurements of memory and learning, calculation, orientation, and visual-spatial ability (all values of p < 0.01). Regarding sex and age moderation, males had a more pronounced association between higher CVR and worse general cognition, immediate recall, orientation, calculation, and visual-spatial ability (all values of p < 0.0001). In contrast, females exhibited a slightly larger negative association in delayed recall. Older participants (>65 years old) had a more pronounced association between higher CVR and worse calculation ability (p = 0.003). Conclusion: CVD are risk factors for lower global cognition and cognitive subdomains in middle-aged and older adults in China.

Vitamin B6, B12, Asam Folat, Tekanan Darah dan Demensia pada Lanjut Usia

Background: Dementia is a multifactorial disease due to genetic and environmental influences. Lack of intake of vitamins B6, B12, folic acid and blood pressure are one of the environmental factors that cause dementia.Objective: To analyze the relationship between the adequacy of vitamins B6, B12, folic acid and blood pressure with dementia in the elderlyMethod: This research was a cross sectional study, which was carried out in Tulungagung Regency. The sampling technique was cluster random sampling and a sample size of 100 elderly from 7 elderly Posyandu in Tulungagung Regency, with independent variables such as adequacy of vitamin B6, B12, folic acid and blood pressure, while the dependent variable was dementia. Data were analyzed with chi square testResults: Respondents in this study were generally aged 60-74 years (70.0%), women (48.0%), were educated in elementary / junior high school (60.0%) and did not work (69.0%). Most respondents have insufficient vitamin B6, B12 and folic acid in the less category, with percentages of 57.0%, 54% and 64%, respectively. There was an association between the adequacy of vitamins B6, B12 and folic acid with dementia in the elderly (OR=2.302; 95% CI=1.011-5.241; p=0.045; OR=2.397; 95% CI=1.060-5.422; p=0.034; OR=2.516; 95% CI=1.015-6.238; p=0.043). Blood pressure is associated with dementia in the elderly (OR=3.000; 95% CI=1.288-6.988; p=0.010). The average consumption of vitamin B6, B12 and folic acid in the normal group was higher than the dementia group, with a difference of 0.16 ± 0.04 mg, 0.54 ± 0.05 mcg and 65.89 ± 4.95 respectively mcgConclusionABSTRAKLatar Belakang: Demensia merupakan penyakit multifaktorial karena pengaruh genetik dan lingkungan. Minimnya asupan vitamin B6, B12, asam folat dan tekanan darah menjadi salah satu faktor lingkungan yang menyebabkan demensia.Tujuan:  Tujuan penelitian ini adalah menganalisis hubungan antara kecukupan vitamin B6, B12, asam folat dan tekanan darah dengan demensia pada lanjut usiaMetode: Penelitian ini berupa penelitian cross sectional, yang dilakukan di Kabupaten Tulungagung. Teknik sampling dengan cluster random sampling dan besar sampel 100 lansia dari 7 posyandu lansia di Kabupaten Tulungagung, dengan variabel bebas berupa kecukupan vitamin B6, B12, asam folat dan tekanan darah, sedangkan variabel terikatnya adalah demensia. Data dianalisis dengan uji chi squareHasil: Responden penelitian ini umumnya berusia 60-74 tahun (70,0 %), wanita (48,0 %), berpendidikan terakhir SD/SMP (60,0 %) dan tidak bekerja (69,0 %). Kebanyakan responden memiliki kecukupan vitamin B6, B12 dan asam folat dalam kategori kurang, dengan persentase masing-masing  57,0 %, 54 % dan 64 %. Ditemukan hubungan antara kecukupan vitamin B6, B12 dan asam folat dengan demensia pada lanjut usia (OR=2,302, 95% CI=1,011-5,241, p=0,045; OR=2,397, 95% CI=1,060-5,422, p=0,034; OR=2,516,95% CI=1,015-6,238, p=0,043). Tekanan darah berhubungan dengan demensia pada lanjut usia (OR=3,000,95% CI=1,288-6,988,p=0,010). Rata-rata konsumsi vitamin B6, B12 dan asam folat kelompok normal lebih tinggi dibandingkan kelompok demensia, dengan selisih masing-masing sebesar 0,16±0,04 mg, 0,54±0,05 mcg dan 65,89 ±4,95 mcg.Kesimpulan: Terdapat hubungan antara kecukupan vitamin B6, B12, asam folat dan tekanan darah dengan demensia pada lanjut usia. 

Associations between major dietary patterns and anxiety in middle-aged adults in eastern China

OBJECTIVE

The current study aimed to evaluate the association of major dietary patterns with anxiety in middle-aged adults in eastern China.

DESIGN

Dietary intake was assessed using a semi-quantitative FFQ. Binary logistic regression analysis was used to estimate OR and 95 % CI for anxiety according to quartiles of each dietary pattern score.

SETTING

Evidence regarding the relationship between dietary patterns and anxiety in the Chinese population is scarce.

PARTICIPANTS

The study participants were 1360 Chinese adults aged 45-59 years, who participated in a health survey at the time of periodic check-up in the city of Linyi, Shandong Province, China.

RESULTS

Four major dietary patterns were identified by factor analysis: traditional Chinese, western, grains-vegetables and high-salt diets. After adjusting for potential confounders, participants in the highest quartile of the western pattern had greater odds for anxiety, compared with those in the lowest quartile (OR 1·35, 95 % CI 1·000, 3·086, P < 0·05). In contrast, participants in the highest quartile of the grains-vegetables pattern had lower odds for anxiety than did those in the lowest quartile (OR 0·78, 95 % CI 0·574, 1·000, P < 0·05). Moreover, no significant associations were observed between the traditional Chinese and high-salt patterns and the risk of anxiety.

CONCLUSIONS

Our findings indicate that the western pattern is associated with an increased risk, and the grains-vegetables pattern is associated with a decreased risk of anxiety.

Risk of neurodegenerative dementia in asthma patients: a nested case-control study using a national sample cohort

OBJECTIVES

This study investigated the risk of neurodegenerative dementia following asthma.

DESIGN

A nested case-control study SETTING: The ≥60-year-old population was selected from the Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2013.

PARTICIPANTS AND INTERVENTIONS

The 11 442 dementia cases were matched with 45 768 control cases for age, sex, income, region of residence, hypertension, diabetes and dyslipidaemia. Asthma was classified using International Classification of Disease-10 (ICD-10) codes (J45 and J46) and medication history. Dementia was identified based on ICD-10 codes (G30 and F00).

PRIMARY AND SECONDARY OUTCOME MEASURES

The ORs of a previous history of asthma in patients with dementia were analysed using conditional logistic regression analysis stratified for age, sex, income, region of residence, hypertension, diabetes and dyslipidaemia. Subgroup analysis was performed according to age and sex.

RESULTS

Overall, 22.6% (2587/11 442) and 22.3% (10 229/45 768) of the cases in the dementia and control groups, respectively, had a previous history of asthma. The OR for asthma in the dementia group was not higher than that in the control group (adjusted OR=0.97, 95% CI 0.92 to 1.02, p=0.207). All age and sex subgroups demonstrated consistent results.

CONCLUSIONS

Asthma was not related to an increased risk of dementia.

Hypertension and Dementia: A comprehensive review from the HOPE Asia Network

Approximately 365 million people in Asia were classified as elderly in 2017. This number is rising and expected to reach approximately 520 million by 2030. The risk of hypertension and cognitive impairment/dementia increases with age. Recent data also show that the prevalence of hypertension and age-related dementia are rising in Asian countries. Moreover, not many people in Asian countries are aware of the relationship between hypertension and cognitive impairment/dementia. Furthermore, hypertension control is poorer in Asia than in developed countries. Hypertension is known to be a major risk factor for damage to target organs, including the brain. Decreased cognitive function can indicate the presence of target organ damage in the brain. Twenty-four-hour blood pressure profiles and blood pressure variability have been associated with cognitive impairment and/or silent cerebral diseases, such as silent cerebral infarction or white matter lesions, which are predisposing conditions for cognitive impairment and dementia. Hypertension that occurs in midlife also affects the incidence of cognitive impairments in later life. Managing and controlling blood pressure could preserve cognitive functions, such as by reducing the risk of vascular dementia and by reducing the global burden of stroke, which also affects cognitive function.