Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal study

Hassing, Linda B.; Hofer, Scott M.; Nilsson, Sven Erik G.; Berg, Stig; Pedersen, Nancy L.; McClearn, Gerald E.; Johansson, Boo

doi:10.1093/ageing/afh100

Cited by 211 publications

(176 citation statements)

References 27 publications

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“…41 At more advanced age, [42][43][44][45][46][47] point estimates went in the same direction but only reached significance in the normotensive Hispanic Established Populations for Epidemiologic Studies of the Elderly cohort 44 and in the Active Cognitive Training for Independent and Vital Elderly Trial. 46 Among the studies with cognitive impairment as a categorical end point (Table 2), 42,48 -61 those using a dichotomized test score 53,57 classified from 15% 53 to 50% 57 of the participants as cognitively impaired and reported positive associations with hypertension.…”

Section: Longitudinal Cohort Studiesmentioning

confidence: 85%

“…To further clarify the role of blood pressure in the pathogenesis of cognitive impairment, we performed a systematic review of the prospective studies published since 2000 until early 2006, from which we extracted or computed summary statistics. The outcome variables were either levels of or changes in single or composite cognitive scores (Table 1) [36][37][38][39][40][41][42][43][44][45][46][47] ; the incidence of cognitive dysfunction, dementia, AD, or VaD (Table 2) 42,48 -61 ; or the appearance of brain lesions in histopathologic or neuroimaging studies (Table 3). [62][63][64][65] For each of these 3 end points, we ordered the reports according to the age at enrollment.…”

Section: Longitudinal Cohort Studiesmentioning

confidence: 99%

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Less Atherosclerosis and Lower Blood Pressure for a Meaningful Life Perspective With More Brain

2007

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T raditional teaching subdivides the dementia syndrome into neurodegenerative Alzheimer's disease (AD), vascular dementia (VaD), and mixed variants. In spite of the vast and continuing literature on the dichotomy between AD and VaD, new emerging concepts highlight the role of cardiovascular risk factors in the pathogenesis of AD, especially in older patients. 1,2 Hypertension is the major player in the pathogenesis of stroke, poststroke dementia, and VaD. AD is the most common cause of dementia, contributing from 45% to Ͼ75% of the cases in Asians and whites, respectively. 3 This review will focus on the role of hypertension as a reversible risk factor in the development of dementia, in particular AD. To set the stage, we will first summarize current insights in the epidemiology of AD, the pathogenesis of VaD and AD, and the association between neurodegeneration and atherosclerosis. Epidemiology of DementiaAcross 36 cross-sectional studies, the prevalence of dementia increased exponentially from 0.3% to 1.0% in subjects aged 60 to 64 years to 10% to 20% in octogenarians and to Ͼ40% in the ninth decade of life. 3 In 15 longitudinal studies, the incidence of dementia showed a similar age-related dependency with rates expressed in new cases per 1000 personyears ranging from 0.4 to 4 at 60 to 64 years to 20 to Ͼ40 at 80 to 85 years. 3 Currently, 24.3 million people have dementia with an annual worldwide incidence of 4.6 million new cases. 4

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Section: Longitudinal Cohort Studiesmentioning

confidence: 85%

Section: Longitudinal Cohort Studiesmentioning

confidence: 99%

Less Atherosclerosis and Lower Blood Pressure for a Meaningful Life Perspective With More Brain

2007

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“…The higher rate of conversion to MCI was replicated in a secondary evaluation of the JNC-8 recommendation to initiate treatment if systolic BP is ≥140 mmHg and diabetes is present. It is reasonable to jointly consider hypertension and diabetes given evidence for their synergistic relationship in increasing the risk of cognitive decline and dementia (24). The NACC database relies on self-report of medical comorbidites as opposed to objective measures such as fasting glucose levels.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Cognitive Functioning and the JNC-8 Guidelines for Hypertension in Older Adults

Goldstein¹,

Hajjar

Dunn³

et al. 2016

GERONA

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Background: Guidelines for hypertension treatment by the Eighth Joint National Committee (JNC-8) in 2014 recommended a target systolic blood pressure (BP) of <150/<90 mmHg in persons older than 60 years, in contrast to the 2003 JNC-7 recommendations of systolic BP <140 mmHg. This study evaluated the implications of raising the BP target on cognitive functioning and conversion from normal cognition to mild cognitive impairment (MCI). Methods: This was a longitudinal study of individuals older than 60 years enrolled in the NIH-NIA Alzheimer's Disease Centers. All had normal cognition at baseline. 453 participants were taking BP medications and had readings of <140/<90 mmHg at four annual visits (reference group). Two other groups consisted of participants with either systolic BP of 140-149 mmHg (n = 112) or ≥150 mmHg (n = 280) on three or four annual visits. Results: Compared with the reference and the 140-149 mmHg groups, those with BP ≥150 mmHg exhibited poorer cognitive status by Year 4 on the Mini-Mental State Exam, and they had a higher risk of conversion to MCI. The 140-149 mmHg exhibited poorer performance than the reference group on domains assessing attention and executive functioning. In contrast, their performance was not significantly different from those with BP ≥150 mmHg. Conclusions: Persons with BP ≥150 mmHg show a faster global cognitive decline and transition to MCI than those with lower BP readings. However, the poor cognitive performance in the attention and executive functioning domains for the 140-149 mmHg group indicates the need for further research evaluating the newer recommended cutoff.

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“…Individuals with type 2 diabetes also have a high prevalence of affective illness, ∼11 to 15% meeting the criteria for major depression [16]. Vascular disease and alterations in glucose, insulin, and amyloid metabolism may be underlying mechanisms that explain the link between diabetes and neuropsychiatric diseases [15,[17][18][19]. A causal relationship between type 2 diabetes and insulin resistance on the one hand, and cognitive impairment, dementia, and major depression on the other, has not yet been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Brain-derived neurotrophic factor (BDNF) and type 2 diabetes

et al. 2006

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Aims/hypothesis Decreased levels of brain-derived neurotrophic factor (BDNF) have been implicated in the pathogenesis of Alzheimer's disease and depression. These disorders are associated with type 2 diabetes, and animal models suggest that BDNF plays a role in insulin resistance. We therefore explored whether BDNF plays a role in human glucose metabolism. Subjects and methods We included (Study 1) 233 humans divided into four groups depending on presence or absence of type 2 diabetes and presence or absence of obesity; and (Study 2) seven healthy volunteers who underwent both a hyperglycaemic and a hyperinsulinaemic-euglycaemic clamp.Results Plasma levels of BDNF in Study 1 were decreased in humans with type 2 diabetes independently of obesity. Plasma BDNF was inversely associated with fasting plasma glucose, but not with insulin. No association was found between the BDNF G196A (Val66Met) polymorphism and diabetes or obesity. In Study 2 an output of BDNF from the human brain was detected at basal conditions. This output was inhibited when blood glucose levels were elevated. In contrast, when plasma insulin was increased while maintaining normal blood glucose, the cerebral output of BDNF was not inhibited, indicating that high levels of glucose, but not insulin, inhibit the output of BDNF from the human brain. Conclusions/interpretation Low levels of BDNF accompany impaired glucose metabolism. Decreased BDNF may be a pathogenetic factor involved not only in dementia and depression, but also in type 2 diabetes, potentially explaining the clustering of these conditions in epidemiological studies.

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Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal study

Abstract: it is concluded that comorbidity of diabetes and hypertension produce a pronounced cognitive decline. This finding emphasises the importance of prevention and treatment of those highly prevalent diseases in the old population.

Cited by 211 publications

References 27 publications

Less Atherosclerosis and Lower Blood Pressure for a Meaningful Life Perspective With More Brain

Less Atherosclerosis and Lower Blood Pressure for a Meaningful Life Perspective With More Brain

The Relationship Between Cognitive Functioning and the JNC-8 Guidelines for Hypertension in Older Adults

Brain-derived neurotrophic factor (BDNF) and type 2 diabetes

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