Hypertension and changes of cognitive function in 81-year-old men

Reinprecht, Faina; Elmståhl, Sölve; Janzon, Lars; André-Petersson, Lena

doi:10.1097/00004872-200301000-00014

Cited by 37 publications

(18 citation statements)

References 29 publications

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“…Observational studies of the association between elevated blood pressure during middle age and late-life cognitive impairment suggest that mid-life hypertension increases the risk of late-life dementia (Kilander et al 2000; Launer et al 2000; Wu et al 2003; Yamada et al 2003; Elias et al 2004; Whitmer et al 2005b). When hypertension is assessed in later life, the association is somewhat ambiguous, in that both high and abnormally low blood pressure are associated with dementia (Skoog et al 1996; Knopman et al 2001; Morris et al 2001; Ruitenberg et al 2001; Tyas et al 2001; Bohannon et al 2002; Lindsay et al 2002; Posner et al 2002; Elias et al 2003; Kuller et al 2003; Piguet et al 2003; Qiu et al 2003; Reinprecht et al 2003; Verghese et al 2003a; Hebert et al 2004; Solfrizzi et al 2004; Tervo et al 2004; Borenstein et al 2005; Petitti et al 2005; Waldstein et al 2005). With Alzheimer disease onset and progression, blood pressure begins to decrease, possibly related to vessel stiffening, weight loss, and changes in the autonomic regulation of blood flow.…”

Section: Antecedent Risk Factors That Increase the Risk Of Alzheimer mentioning

confidence: 99%

Epidemiology of Alzheimer Disease

Mayeux¹,

Stern²

2012

Cold Spring Harbor Perspectives in Medicine

773

454

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The global prevalence of dementia has been estimated to be as high as 24 million, and is predicted to double every 20 years until at least 2040. As the population worldwide continues to age, the number of individuals at risk will also increase, particularly among the very old. Alzheimer disease is the leading cause of dementia beginning with impaired memory. The neuropathological hallmarks of Alzheimer disease include diffuse and neuritic extracellular amyloid plaques in brain that are frequently surrounded by dystrophic neurites and intra-neuronal neurofibrillary tangles. The etiology of Alzheimer disease remains unclear, but it is likely to be the result of both genetic and environmental factors. In this review we discuss the prevalence and incidence rates, the established environmental risk factors, and the protective factors, and briefly review genetic variants predisposing to disease.

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Section: Antecedent Risk Factors That Increase the Risk Of Alzheimer mentioning

confidence: 99%

Epidemiology of Alzheimer Disease

Mayeux¹,

Stern²

2012

Cold Spring Harbor Perspectives in Medicine

773

454

View full text Add to dashboard Cite

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“…In 1995–1996, 186 of the 266 surviving participants from the ongoing prospective population study on cardiovascular disease, “Men born in 1914”,8,9 still living in Malmö agreed to take part in a new investigation. One man was excluded after failing to participate in the physical health examination.…”

Section: Methodsmentioning

confidence: 99%

“…The ultrasound examination of the carotid artery was performed with an Acuson XP 10 Computed sonography system (Acuson, Mountain View, CA, USA), using a 7 MHz B-mode real-time linear scanner including a 5 MHz pulsed and color-coded Doppler and the method is described elsewhere 19. Carotid artery disease was defined as a maximum frequency shift (MFS) > 3,1 kHz (corresponding to a stenosis of more than 30% of the cross-sectional diameter of the internal carotid artery lumen) or occlusion of carotid artery unilaterally or bilaterally 19.…”

Section: Methodsmentioning

confidence: 99%

“…Carotid artery disease was defined as a maximum frequency shift (MFS) > 3,1 kHz (corresponding to a stenosis of more than 30% of the cross-sectional diameter of the internal carotid artery lumen) or occlusion of carotid artery unilaterally or bilaterally 19. Ankle-brachial BP index recording of SBP was measured with a sphygmomanometer in both upper arms and at both ankle levels, using a mercury strain gauge as pulse detector 19. For each leg, an ankle-brachial pressure index (ABPI) was calculated by dividing the ankle SBP with the highest upper arm SBP value.…”

Section: Methodsmentioning

confidence: 99%

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Ambulatory recorded ST segment depression on ECG is associated with lower cognitive function in healthy elderly men

Elmståhl¹

2009

IJGM

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ST segment depression (STDE) has been found to be associated with cardiovascular disease in the elderly. Studies of the relation of ambulatory STDE to cognitive function in elderly persons aged 80 years or above is lacking.Objective:To study the association between STDE and cognition.Design and participants:A cross-sectional cohort study of 88 81-year-old men from the population study “Men born in 1914” investigated in an outpatient research clinic. Measurements included ambulatory 24-hour electrocardiogram (ECG) monitoring and a cognitive test battery of six tests. Proportion of lower cognitive function was calculated for each test in relation to STDE during the day and at night-time.Results:Fifty-eight percent of the men had STDE and a higher proportion with low visuospatial cognitive function was found among those with STDE compared to the others (84% vs 59%; p = 0.014). A significant trend was noted for subjects without STDE compared to STDE night-time less than 60 minutes and night-time more than 60 minutes for spatial and verbal cognitive functions (p = 0.022). No trends were noted for STDE daytime. Maximal STDE during night showed similar association to spatial function (Benton Visual Retention test, r = −0.26; p = 0.028). Even when seven subjects with a history of stroke were excluded, the occurrence of STDE was associated to lower visuospatial cognitive function compared to those without STDE (87% vs 57%; p = 0.004).Conclusion:ST segment depression on ECG is common among elderly men and might be a vascular risk factor for cognitive deterioration.

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“…In addition to its role in developing cardiovascular disease and stroke, hypertension is also a risk factor for cognitive impairment [1-5] Although blood pressure tends to decline around the time of onset of clinical cognitive impairment[3], hypertension leads to accelerated decline in those with cognitive impairment or dementia[6,7] Of all the cognitive domains, executive function is more vulnerable to the effects of hypertension [8-10] Executive function is defined as the set of cognitive skills that are responsible for the planning, initiation, sequencing, and monitoring of complex goal-directed behavior[11] Seniors suffering from executive dysfunction have significant impairment in following medical advise [12] and are more likely to develop disability[13,14] It is estimated that close to 30% of the elderly population have executive function abnormalities and are generally undetected[15,16] No prior research has evaluated the effect of hypertension treatment on executive function or specifically enrolled those with executive dysfunction.…”

Section: Introductionmentioning

confidence: 99%

The rationale and design of the antihypertensives and vascular, endothelial, and cognitive function (AVEC) trial in elderly hypertensives with early cognitive impairment: Role of the renin angiotensin system inhibition

et al. 2009

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BackgroundPrior evidence suggests that the renin angiotensin system and antihypertensives that inhibit this system play a role in cognitive, central vascular, and endothelial function. Our objective is to conduct a double-blind randomized controlled clinical trial, the antihypertensives and vascular, endothelial, and cognitive function (AVEC), to compare 1 year treatment of 3 antihypertensives (lisinopril, candesartan, or hydrochlorothiazide) in their effect on memory and executive function, cerebral blood flow, and central endothelial function of seniors with hypertension and early objective evidence of executive or memory impairments.Methods/DesignThe overall experimental design of the AVEC trial is a 3-arm double blind randomized controlled clinical trial. A total of 100 community eligible individuals (60 years or older) with hypertension and early cognitive impairment are being recruited from the greater Boston area and randomized to lisinopril, candesartan, or hydrochlorothiazide ("active control") for 12 months. The goal of the intervention is to achieve blood pressure control defined as SBP < 140 mm Hg and DBP < 90 mm Hg. Additional antihypertensives are added to achieve this goal if needed. Eligible participants are those with hypertension, defined as a blood pressure 140/90 mm Hg or greater, early cognitive impairment without dementia defined (10 or less out of 15 on the executive clock draw test or 1 standard deviation below the mean on the immediate memory subtest of the repeatable battery for the assessment of neuropsychological status and Mini-Mental-Status-exam >20 and without clinical diagnosis of dementia or Alzheimer's disease). Individuals who are currently receiving antihypertensives are eligible to participate if the participants and the primary care providers are willing to taper their antihypertensives. Participants undergo cognitive assessment, measurements of cerebral blood flow using Transcranial Doppler, and central endothelial function by measuring changes in cerebral blood flow in response to changes in end tidal carbon dioxide at baseline (off antihypertensives), 6, and 12 months. Our outcomes are change in cognitive function score (executive and memory), cerebral blood flow, and carbon dioxide cerebral vasoreactivity.DiscussionThe AVEC trial is the first study to explore impact of antihypertensives in those who are showing early evidence of cognitive difficulties that did not reach the threshold of dementia. Success of this trial will offer new therapeutic application of antihypertensives that inhibit the renin angiotensin system and new insights in the role of this system in aging.Trial RegistrationClinicaltrials.gov NCT00605072

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Hypertension and changes of cognitive function in 81-year-old men

Abstract: Evidence is found to support the hypothesis that hypertension, especially high DBP in late midlife, is associated with a decline in spatial performance of cognitive functions in elderly men.

Cited by 37 publications

References 29 publications

Epidemiology of Alzheimer Disease

Epidemiology of Alzheimer Disease

Ambulatory recorded ST segment depression on ECG is associated with lower cognitive function in healthy elderly men

The rationale and design of the antihypertensives and vascular, endothelial, and cognitive function (AVEC) trial in elderly hypertensives with early cognitive impairment: Role of the renin angiotensin system inhibition

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