Temporal Evolution of Cognitive Changes in Incident Hypertension

Abstract

245I dentifying modifiable risk factors for cognitive decline and dementia is crucial to effective preventive strategies. Known risk factors include age, education, physical activity, diet, depression, and vascular disease.1 Although the dementia prevalence increases exponentially from 65 years of age, the risk builds up gradually with critical periods for some exposures across the life span. 2Cognitive decline from previous levels of functioning is a core criterion for the diagnosis of dementia.3 Findings from observational studies suggest that hypertension is a major risk factor for accelerated cognitive decline 4 and dementia. 5Hypertension predicts decline in the domains of memory, attention, 6 psychomotor speed, 7 and other fluid abilities. 8The effect of hypertension seems to be age dependent for the associations with cognitive decline and dementia 9 : Studies into midlife hypertension have generally found positive associations, 8,10,11 whereas studies into late life hypertension are more likely to show mixed results of a risk increasing, no, or even a protective effect. 8,12 Prospective studies with exceptionally long follow-up duration suggest an inverted U-shaped trajectory of blood pressure (BP) over time in people who later develop dementia (ie, an increase from midlife to late life and declining levels thereafter). 13,14 Understanding the effect of hypertension on cognitive decline and dementia is important because it opens the possibility of risk management using available interventions. 15,16 Observational studies have shown that individuals with pharmacologically controlled hypertension decline less than people with uncontrolled or untreated hypertension.4 Meta-analysis of randomized clinical trials found a significant dementia risk reduction in trials that prescribed diuretics or calcium channel blockers in the treatment arm, although no generic effect of hypertension medication was found. 17Most might be gained from timely interventions in newly diagnosed hypertension cases, but, to the best of our knowledge, no study has focused on the onset and course of cognitive decline in incident hypertension. One previous study of 49 healthy older adults used incident hypertension as a covariate when studying risk for white matter lesion progression on cognitive impairment (average follow-up, 5.6 years).18 ItAbstract-Midlife hypertension is a risk factor for dementia, but little is known about the cognitive trajectories of individuals with incident hypertension. This study follows the cognitive functioning in prevalent and incident hypertension for 12 years and in relation to age and treatment status. Cognitively intact adults aged 25 to 84 years (n=1805) were serially assessed at baseline, 6 years, and 12 years. Hypertension was defined by sphygmomanometry or antihypertensive medication use, and its association with cognitive decline was tested in random-effects models. At baseline, 638 (35.3%) participants had hypertension. They showed faster decline in memory (χ 2 test for homogeneity=35.75; df=2; P<0....

Both Low and High 24-Hour Diastolic Blood Pressure Are Associated With Worse Cognitive Performance in Type 2 Diabetes: The Maastricht Study

“…Due to the cross-sectional design, we were unable to examine temporality of effects, let alone causal relationships. Although we used tests for cognitive domains that have been shown to be sensitive to effects of hypertension (52), it is possible that we missed subtle effects of BP on cognitive functions in the group without diabetes, which was healthier and younger. Such effects may become manifest in longitudinal data where participants show more advanced stages of cognitive aging (52).…”

The Elusive Nature of APOE ε4 in Mid-adulthood: Understanding the Cognitive Profile

“…hypertension, high cholesterol and diabetes (Atzmon et al, 2002;Köhler et al, 2014;van Exel et al, 2002;Whitmer, Sidney, Selby, Johnston, & Yaffe, 2005), and interactions between vascular health, APOE and cognition are reported (de Frias, Schaie, & Willis, 2014;Peila et al, 2001;Puttonen, Elovainio, Kivimäki, Lehtimäki, & Keltikangas-Järvinen, 2003;Zade et al, 2010). Current behavioural research is neither considering the potential modifying effects of wider risk factors nor adequately controlling for them, though they undoubtedly contribute to the cognitive ageing trajectory (Herrup, 2010).…”

Hypertension and cognitive impairment: the standpoint of evidence-based medicine

“…В ряде исследований выявлена связь между повышен-ным уровнем АД и/или наличием диагноза АГ в среднем возрасте и состоянием когнитивных функций в пожилом и старческом возрасте [11][12][13][14][15][16][17][18][19]. Так, во Фрамингемском ис-следовании установлено, что увеличение САД и ДАД на ка-ждые 10 мм рт.…”

“…Kоhler и соавт. [18] установили, что у пациентов сред-него возраста с АГ через 6 и 12 лет наблюдения происходит достоверное снижение слухоречевой памяти, управляющих функций и скорости обработки информации. В то же время у пациентов, у которых АГ была диагностирована в процессе наблюдения (на момент включения в исследование АД у них находилось пределах в нормы), КН в конце исследования были выражены в достоверно меньшей степени, чем у боль-ных, имевших АГ на момент исходного визита.…”