Heart health meets cognitive health: evidence on the role of blood pressure

Palta, Priya; Albert, Marilyn; Gottesman, Rebecca F.

doi:10.1016/s1474-4422(21)00248-9

Cited by 32 publications

(44 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some have raised concerns regarding the inclusion of socioeconomically, racially, and ethnically diverse individuals. 78 Despite high overall visit adherence in the SPRINT-MIND study, individuals who did not complete a cognitive assessment during follow-up were more likely to be women, Black, frail, and depressed, with lower cognitive scores at baseline. Individuals with low baseline education were often excluded from trial participation, prompting some authors to call for more studies on optimal timing of BP lowering, specific BP targets, and the inclusion of more diverse populations.…”

Section: Gaps and Challengesmentioning

confidence: 96%

Section: Management and Reversibilitymentioning

confidence: 99%

“…77 Still, some have argued that cumulative evidence has shown that BP control is associated with improved cognitive outcomes and compelling observational data support antihypertensive medication use for dementia prevention. 78 A 2021 Cochrane review concluded: "High certainty randomised controlled trial evidence regarding hypertension treatment on dementia and cognitive decline does not yet exist. " 79 The obvious omission is that none of these pivotal trials included VCI or vascular dementia as their primary outcome.…”

Section: Gaps and Challengesmentioning

confidence: 99%

“…Individuals with low baseline education were often excluded from trial participation, prompting some authors to call for more studies on optimal timing of BP lowering, specific BP targets, and the inclusion of more diverse populations. 78 INFINITY is the only trial that specifically examined WMH as a potential risk factor or co-pathology of VCI, including both mobility and change in WMH as their primary outcomes. 63 Post hoc analyses of SPRINT-MIND have revealed that intensive BP lowering may modify brain changes associated with neurodegeneration, hippocampal atrophy, and WMH accumulation.…”

Section: Gaps and Challengesmentioning

confidence: 99%

See 3 more Smart Citations

Blood Pressure and Vascular Cognitive Impairment

Levine

Springer

Brodtmann

2022

Stroke

View full text Add to dashboard Cite

High blood pressure (BP) is detrimental to brain health. High BP contributes to cognitive impairment and dementia through pathways independent of clinical stroke. Emerging evidence shows that the deleterious effect of high BP on cognition occurs across the life span, increasing the risk for early-onset and late-life dementia. The term vascular cognitive impairment includes cognitive disorders associated with cerebrovascular disease, regardless of the pathogenesis. This focused report is a narrative review that aims to summarize the epidemiology of BP and vascular cognitive impairment, including differences by sex, race, and ethnicity, as well as the management and reversibility of BP and vascular cognitive impairment. It also discusses knowledge gaps and future directions.

show abstract

Section: Gaps and Challengesmentioning

confidence: 96%

Section: Management and Reversibilitymentioning

confidence: 99%

Section: Gaps and Challengesmentioning

confidence: 99%

Section: Gaps and Challengesmentioning

confidence: 99%

See 2 more Smart Citations

Blood Pressure and Vascular Cognitive Impairment

Levine

Springer

Brodtmann

2022

Stroke

View full text Add to dashboard Cite

show abstract

“…This aspect could play an important role in the development of cognitive impairments after COVID-19 since a correlation between hypertension and cognitive functioning has been demonstrated [ 16 , 17 ]. Several observational studies showed that high BP, associated with increased inflammation and oxidative stress, functional and structural vascular changes, and vascular dysregulation, can trigger cerebral small vessel disease, stroke, reduction in brain volumes and ultimately dementia [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Impairment in Convalescent COVID-19 Patients Undergoing Multidisciplinary Rehabilitation: The Association with the Clinical and Functional Status

et al. 2022

View full text Add to dashboard Cite

Background. Cognitive impairment has been reported in the aftermath of severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection. We investigated the possible association between cognitive impairment and the main clinical and functional status variables in a cohort of convalescent COVID-19 patients without premorbid diseases potentially affecting cognition. Methods. We consecutively screened for inclusion of convalescent COVID-19 patients referring to a post-acute care facility for pulmonary rehabilitation. All the enrolled patients were assessed for cognitive functions. We also investigated features of psychological distress (anxiety, depression, symptoms of posttraumatic stress disorder and quality of life) and cardiac and pulmonary functional status. Results. The 63 enrolled patients (mean age 59.82 ± 10.78, male gender = 47) showed a high frequency of depressive symptoms (76.2%) and anxiety (55.5%), and a high prevalence of symptoms of posttraumatic stress disorder (PTSD, 44.4%). About half of the total sample showed reduced cognitive efficiency (RCE, 44.4%) in the domains of spatial and verbal long-term memory and executive functions. Patients with RCE more frequently showed alteration of blood pressure (BP) circadian rhythm (p = 0.01), higher levels of D-Dimer (p = 0.03), had experienced a severe illness (p = 0.02), had longer disease duration (p = 0.04), more clinically relevant symptoms of PTSD (p = 0.02), more frequent cognitive complaints (p = 0.002), higher anxiety scores (p = 0.01) and lower quality of life (p = 0.02) than patients with normal cognitive efficiency. Conclusions. Our findings indicated a possible association between the RCE after COVID-19 and some cardiological variables, including some indirect measures of a residual autonomic disorder, such as the presence of an altered BP circadian rhythm. Future research studies with large samples are needed to provide valid conclusions.

show abstract

The apathy, gait impairment, and executive dysfunction (AGED) triad vascular variant

Hachinski

Finger

Pieruccini‐Faria

et al. 2022

Alzheimer's & Dementia

View full text Add to dashboard Cite

Apathy, gait disturbances, and executive dysfunction (AGED) often occur together. Although they can arise independently, the presence of one might portend another. This recognition suggests the possible etiology. We focus on the most common, the vascular. We explain the AGED vascular mechanism through the ambibaric brain concept. The brain contains two complementary blood pressure systems: One high in the primitive brain (brainstem, basal ganglia, and thalamus) and a low‐pressure system in the Homo sapiens brain (cerebral hemispheres). Hypertension inflicts the most damage on the primitive brain. The frontal systems connect to the basal ganglia, then the thalamus and back to the cortex. Many connections converge on the primitive brain where they are damaged by vascular disease. We need methods of determining optimal, individual blood pressures. Although the AGED triad can result from other causes, it should first signal a vascular etiology, the most prevalent, treatable, and preventable one.

show abstract

Heart health meets cognitive health: evidence on the role of blood pressure

Cited by 32 publications

References 98 publications

Blood Pressure and Vascular Cognitive Impairment

Blood Pressure and Vascular Cognitive Impairment

Cognitive Impairment in Convalescent COVID-19 Patients Undergoing Multidisciplinary Rehabilitation: The Association with the Clinical and Functional Status

The apathy, gait impairment, and executive dysfunction (AGED) triad vascular variant

Contact Info

Product

Resources

About