Association of Midlife to Late-Life Blood Pressure Patterns With Incident Dementia

Abstract

IMPORTANCE The association between late-life blood pressure (BP) and cognition may depend on the presence and chronicity of past hypertension. Late-life declines in blood pressure following prolonged hypertension may be associated with poor cognitive outcomes. OBJECTIVE To examine the association of midlife to late-life BP patterns with subsequent dementia, mild cognitive impairment, and cognitive decline. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities prospective population-based cohort study enrolled 4761 participants during midlife (visit 1, 1987-1989) and followed-up over 6 visits through 2016-2017 (visit 6). BP was examined over 24 years at 5 in-person visits between visits 1 and 5 (2011-2013). During visits 5 and 6, participants underwent detailed neurocognitive evaluation. The setting was 4 US communities:

Additive interaction of mid- to late-life depression and cerebrovascular disease on the risk of dementia: A nationwide population-based cohort study

“…This is consistent with previous studies which reported that post-stroke dementia is more prevalent in men [50]. In large-scale populationbased cohort studies on the association of cardiovascular risk [51] and blood pressure pattern [52] with cognitive function, researchers have consistently reported that mid-life vascular disease has a more substantial effect on dementia onset. Our ndings highlight the importance of midlife as a critical period for later cognitive function.…”

Association of Late Life Depression, (Non-) Modifiable Risk and Protective Factors with Dementia and Alzheimer’s Disease: Literature Review on Current Evidences, Preventive Interventions and Possible Future Trends in Prevention and Treatment of Dementia

“…It has been also found that in contrast to vascular dementia, where an increased level of Aβ peptide is observed, the dementia level of AD is linked with a low level of Aβ peptide [ 85 ]. This strong impact of midlife chronic hypertension on the increased risk for dementia in later life has been supported by a 24-year follow-up study carried out on 4751 individuals [ 86 ]. Surprisingly, a protective function of high blood pressure in the oldest-old has been found for individuals with hypertension developed in late life [ 87 ].…”

Decrease in Serum HDL-C Level Is Associated with Elevation of Blood Pressure: Correlation Analysis from the Korean National Health and Nutrition Examination Survey 2017

“…high total cholesterol (TC) and low high-density lipoproteins-cholesterol (HDL-C) are also independent risk factors of cardiovascular disease and cerebrovascular disease [5]. However, there has been no correlation analysis between change in blood pressure and HDL-C in general population.Hypertension in midlife is also a strong and independent risk factor of Alzheimer's disease and vascular dementia in late-life [6,7], because individuals who develop hypertension earlier in life are likely to be exposed to the deleterious neurological effects of hypertension for many decades. The higher midlife BP was associated with incidence of dementia in late-life [6].…”

“…However, there has been no correlation analysis between change in blood pressure and HDL-C in general population.Hypertension in midlife is also a strong and independent risk factor of Alzheimer's disease and vascular dementia in late-life [6,7], because individuals who develop hypertension earlier in life are likely to be exposed to the deleterious neurological effects of hypertension for many decades. The higher midlife BP was associated with incidence of dementia in late-life [6]. Interestingly, subjects with midlife hypertension and late-life hypotension had a 4.26-fold higher risk of dementia.…”