Impact of arterial hypertension and its management strategies on cognitive function and dementia: a comprehensive umbrella review

Antonazzo, Barbara; Marano, Giuseppe; Romagnoli, Enrico; Ronzoni, S.; Frati, Giacomo; Sani, Gabriele; Janiri, Luigi; Mazza, Marianna

doi:10.23736/s2724-5683.20.05452-3

Cited by 4 publications

(3 citation statements)

References 53 publications

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“…Although some of these features possibly could represent early symptoms of AD, and thus not be true features of cognitive resilience, they are in agreement with recent studies on the benefits to CR from maintaining good mental health, such as reduced stress at work, conscientiousness [ 37 , 41 ], and social networks [ 35 , 38 ], as well as having good cardiovascular health [ 42 ]. The impacts of diastolic and systolic blood pressure on our CR scores align with some of the heterogeneous reports of the associations of arterial blood pressure measurements with cognitive decline in older individuals [ 43 ]. Although associative and not necessarily deterministic of CR, these data are potentially important because they support lifestyle and medical interventions that may promote CR rather than the more static view of educational attainment, likely a proxy for a complex set of historical events, as contributors to CR.…”

Section: Discussionsupporting

confidence: 84%

Quantitative estimate of cognitive resilience and its medical and genetic associations

Phongpreecha,

Godrich,

Berson

et al. 2023

Alz Res Therapy

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Background We have proposed that cognitive resilience (CR) counteracts brain damage from Alzheimer’s disease (AD) or AD-related dementias such that older individuals who harbor neurodegenerative disease burden sufficient to cause dementia remain cognitively normal. However, CR traditionally is considered a binary trait, capturing only the most extreme examples, and is often inconsistently defined. Methods This study addressed existing discrepancies and shortcomings of the current CR definition by proposing a framework for defining CR as a continuous variable for each neuropsychological test. The linear equations clarified CR’s relationship to closely related terms, including cognitive function, reserve, compensation, and damage. Primarily, resilience is defined as a function of cognitive performance and damage from neuropathologic damage. As such, the study utilized data from 844 individuals (age = 79 ± 12, 44% female) in the National Alzheimer’s Coordinating Center cohort that met our inclusion criteria of comprehensive lesion rankings for 17 neuropathologic features and complete neuropsychological test results. Machine learning models and GWAS then were used to identify medical and genetic factors that are associated with CR. Results CR varied across five cognitive assessments and was greater in female participants, associated with longer survival, and weakly associated with educational attainment or APOE ε4 allele. In contrast, damage was strongly associated with APOE ε4 allele (P value < 0.0001). Major predictors of CR were cardiovascular health and social interactions, as well as the absence of behavioral symptoms. Conclusions Our framework explicitly decoupled the effects of CR from neuropathologic damage. Characterizations and genetic association study of these two components suggest that the underlying CR mechanism has minimal overlap with the disease mechanism. Moreover, the identified medical features associated with CR suggest modifiable features to counteract clinical expression of damage and maintain cognitive function in older individuals.

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Section: Discussionsupporting

confidence: 84%

Quantitative estimate of cognitive resilience and its medical and genetic associations

Phongpreecha,

Godrich,

Berson

et al. 2023

Alz Res Therapy

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“…On the one hand, pastoral older adults have lower educational attainment, which affects their cognitive abilities; on the other hand, because of medical resource limitations, rural health care and nursing conditions are worse, making it difficult to meet the demands of older patients with cognitive dysfunction. It has been identified hypertension is strongly associated with cognitive impairment (Ungvari et al, 2021;Antonazzo et al, 2022). A cross-sectional study compared cognitive function in 221 (71 normotensive and 150 hypertensives) patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of preoperative cognitive impairment among elderly thoracic surgery patients and association with postoperative delirium: a prospective observational study

Miao

et al. 2023

Front. Hum. Neurosci.

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BackgroundPreoperative cognitive impairment (PCI) may increase the incidence of postoperative delirium (POD), yet screening for cognitive impairment is rarely performed. This study hypothesized that Mini-Cog for preoperative cognitive impairment screening predicts postoperative delirium.MethodsThe prospective observational study recruited 153 elderly patients presenting for elective thoracic surgery. Cognitive function of these patients was screened using Mini-Cog preoperatively. We considered that patients with Mini-Cog scores ≤ 3 had cognitive impairment. Delirium was assessed using the Short CAM scale on postoperative days 1–5.ResultsOf the 153 participants, 54 (35.3%) were assigned to the PCI group, and 99 (64.7%) were assigned to the Normal group. Place of residence, education level, and history of hypertension were significantly different between the two groups (P < 0.05). 51 (33.3%) patients developed POD. Multifactorial analysis revealed that PCI (OR = 2.37, P = 0.028), older age (OR = 1.13, P = 0.009), ASA grade III (OR = 2.75, P = 0.012), and longer duration of anesthesia (OR = 1.01, P = 0.007) were associated with POD.ConclusionPreoperative cognitive impairment is strongly associated with POD. Mini-Cog could be recommended for screening PCI.Clinical trial registrationClinicalTrials.gov, identifier NCT05798767.

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“…A cross-sectional study by Zúñiga-Salazar et al shows that hypertension is correlated with MCI [26]. In a comprehensive analysis that encompassed 17 distinct systematic reviews, it was concluded that hypertension increases the risk of VaD and cognitive decline, although the link to AD is less pronounced [31]. However, some other studies have proposed either that there is no connection between hypertension and dementia [32,33] or that the relationship is the opposite, suggesting a protective effect [34].…”

Section: Terminology Definitionmentioning

confidence: 99%

The Relation Between Arterial Hypertension and Cognitive Impairment: A Literature Review

Zúñiga Salazar,

Zúñiga,

Balasubramanian

et al. 2024

Cureus

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The global increase in dementia cases, driven by improved life expectancy and reduced elderly mortality rates, presents a significant public health challenge. Dementia, characterized by a gradual and irreversible decline in cognitive abilities, affects individuals aged 65 and older, disrupting lives and straining healthcare systems. Hypertension significantly influences dementia development. Research consistently links midlife hypertension to cognitive decline, mild cognitive impairment (MCI), and dementia, but findings in older adults vary. While some studies suggest that late-life hypertension accelerates cognitive decline and dementia risk, others propose a protective effect. The impact of hypertension on cognition varies across age groups, spanning from childhood to late life. High blood pressure during midlife and earlier life stages consistently predicts poorer cognitive outcomes. Executive function, attention, and motor speed are the cognitive domains most affected by hypertension, particularly in subcortical diseases. Memory impairments in hypertension-related dementias are complex, often overlapping with other causes. Understanding the inconsistent findings in older adults regarding hypertension, cognitive decline, and dementia risk requires comprehensive exploration of methodological and biological factors. Addressing hypertension and its management may hold the key to reducing the risk of cognitive decline and dementia, especially in midlife and earlier life stages.

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Impact of arterial hypertension and its management strategies on cognitive function and dementia: a comprehensive umbrella review

Cited by 4 publications

References 53 publications

Quantitative estimate of cognitive resilience and its medical and genetic associations

Quantitative estimate of cognitive resilience and its medical and genetic associations

Prevalence of preoperative cognitive impairment among elderly thoracic surgery patients and association with postoperative delirium: a prospective observational study

The Relation Between Arterial Hypertension and Cognitive Impairment: A Literature Review

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