Absence of Nocturnal Fall in Blood Pressure in Elderly Persons with Alzheimer‐Type Dementia

Abstract

Circadian changes of the blood pressure and heart rate in elderly normotensive bedridden patients with severe dementia of the Alzheimer type (group D) were compared with those in elderly normotensive bedridden patients without dementia (group R), normotensive subjects with normal daily activity (group N), and hypertensive patients with normal daily activity (group H). In groups R, N, and H, the blood pressure increased in the afternoon and decreased at midnight; in group D, however, although it increased in the afternoon, it did not decrease at night. The circadian changes of the heart rate were similar in all four groups, showing maxima in the afternoon and minima at midnight. Thus, a specific alteration was found in the circadian rhythm of the blood pressure in patients with Alzheimer-type dementia.

Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension

“…Otsuka et al [27] showed that nocturnal BP does not fall in elderly patients with Alzheimer's-type dementia. On the contrary, Kario and Shimada [28] presented an elderly hypertensive patient whose diurnal BP pattern changed after a minor ischemic stroke, suggesting that abnormal diurnal BP might originate from minor cerebrovascular ischemia.…”

Propionibacterium acnes in the cortex of patients with Alzheimer's disease

“…There is capillary microangiopathy especially in the cortex of patients with Alzheimer's disease [20]. The causes of this microangiopathy are probably similar as in other cases of microangiopathy [12]: Vascular risk factors such as old age, high blood pressure and type-II diabetes (including prediabetes/hyperinsulinemia) [2,5,6,17,18]. The fact that apolipoprotein E4 [3] and lack of estrogen in postmenopausal women are risk factors for Alzheimer's disease agree with this interpretation.…”

Preserved Blood Pressure and Heart Rate Circadian Rhythm in Early Stage Alzheimer's Disease

“…The reasons for this circadian susceptibility reside in the fact that AD affects the central nervous system, not only in the cognitive part, but also in the neuro-endocrine-vegetative sections, such as the hypothalamus and the suprachiasmatic nuclei (8,24-28), which notoriously regulate the circadian rhythmicity of many fundamental systems of human body (1-3). As far as the BP and HR circadian rhythm is concerned, the evidence existing in literature is in keeping with a possible loss of their circadian periodicity in most AD patients (15)(16)(17).…”

“…Additionally, it has been found that AD is strongly disturbed in the day-night excursion of blood pressure (BP) because of the lack in nocturnal decrease (15)(16)(17), causing a condition called "non-dipping phenomenon" as well as cases defined "non-dippers. "…”