The prognostic role of high blood pressure and the aggressiveness of blood pressure lowering in dementia are not well characterized. OBJECTIVE To assess whether office blood pressure, ambulatory blood pressure monitoring, or the use of antihypertensive drugs (AHDs) predict the progression of cognitive decline in patients with overt dementia and mild cognitive impairment (MCI). DESIGN, SETTING, AND PARTICIPANTS Cohort study between June 1, 2009, and December 31, 2012, with a median 9-month follow-up of patients with dementia and MCI in 2 outpatient memory clinics. MAIN OUTCOMES AND MEASURES Cognitive decline, defined as a Mini-Mental State Examination (MMSE) score change between baseline and follow-up. RESULTS We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4). Among them, 68.0% had dementia, 32.0% had MCI, and 69.8% were being treated with AHDs. Patients in the lowest tertile of daytime systolic blood pressure (SBP) (Յ128 mm Hg) showed a greater MMSE score change (mean [SD], −2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], −0.7 [2.5]; P = .002) and patients in the highest tertile (Ն145 mm Hg) (mean [SD], −0.7 [3.7]; P = .003). The association was significant in the dementia and MCI subgroups only among patients treated with AHDs. In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups. The association between office SBP and MMSE score change was weaker. Other ambulatory blood pressure monitoring variables were not associated with MMSE score change. CONCLUSIONS AND RELEVANCE Low daytime SBP was independently associated with a greater progression of cognitive decline in older patients with dementia and MCI among those treated with AHDs. Excessive SBP lowering may be harmful for older patients with cognitive impairment. Ambulatory blood pressure monitoring can be useful to help avoid high blood pressure overtreatment in this population.

A 2-month period of DC assistance is effective in reducing behavioral and psychological symptoms of dementia patients and in alleviating caregivers' burden.

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Background: Although antidepressant drugs (ATD) are frequently prescribed to patients with Alzheimer’s disease (AD), their effect on cognitive status has been only rarely assessed. Methods: The impact of depressive symptoms and ATD on cognitive status was retrospectively assessed in 72 older AD outpatients with mild-to-moderate cognitive impairment, treated with cholinesterase inhibitors, over a 9-month follow-up. Results: Compared to subjects without baseline depressive symptoms, those with symptoms who were continuously treated with ATD had less cognitive decline; those never treated, or not continuously treated despite baseline symptoms, had an intermediate trend. Such a protective action of ATD was, at least in part, independent of their action on depressive symptoms. Conclusion: These observations suggest that ATD may reduce cognitive decline in depressed older AD patients.

Operationalizing MCI criteria changes the relative frequency of MCI subtypes. Nonamnestic single domain MCI may be a previously nonrecognized type of MCI associated with SVD.