Hypertension is Associated With Cognitive Decline in Elderly People at High Risk for Dementia

doi:10.1097/JGP.0b013e31820ee833

The American Journal of Geriatric Psychiatry

Volume 20, Issue 2, February 2012, Pages 179-187

https://doi.org/10.1097/JGP.0b013e31820ee833 Get rights and content

Cardiovascular risk factors including hypertension (HTN) have been shown to increase the risk of Alzheimer disease. The current study investigated whether individuals with HTN are more susceptible to increased cognitive decline and whether the influence of HTN on cognitive decline varied as a function of dementia severity. A total of 224 nursing home and assisted living residents, with a mean age of 84.9 (±7.6) years, were assessed longitudinally with Mini Mental State Exams (MMSEs) and Clinical Dementia Ratings (CDR). Baseline dementia status was defined by the CDR score. As described in Table 2, MMSE scores in persons with HTN and questionable dementia (CDR = 0.5) declined significantly faster than nonhypertensive questionably demented persons. Hypertensive participants did not decline significantly faster than nonhypertensive participants in persons with intact cognition (CDR = 0) or frank dementia (CDR ≥ 1). These results suggest an increased risk of subsequent cognitive decline in hypertensive individuals who are especially vulnerable to developing dementia and raises the possibility that avoiding or controlling HTN might reduce the rate of cognitive decline in cognitively vulnerable individuals, potentially delaying their conversion to full-fledged dementia.

Section snippets

OBJECTIVES

Cardiovascular (CV) disease and dementia are disorders common in the geriatric population.¹ Although the link between CV risk factors and vascular dementia has been observed for some time,2, 3, 4 links between CV risk factors and cognitive impairment due to nonvascular causes, including Alzheimer disease (AD) have also been noted.5, 6, 7, 8

Hypertension (HTN) is a CV disease risk factor that affects 65% of the population age 65 and older⁹ and nonvascular dementia (e.g., AD) affects nearly 5

Participants

The sample consisted of 224 residents of the Jewish Home and Hospital (JHH), Bronx and Manhattan divisions, both skilled nursing facilities, and Kittay House, an assisted living facility affiliated with the JHH. Residents of these nursing homes and assisted living facilities comprised persons who are unable to live independently for a variety of reasons including financial (inability to afford home health care), physical (e.g., hip fracture leading to reduced mobility), frailty due to medical

Mini Mental State Exam

Each participant was serially assessed at approximately annual intervals with a Mini Mental State Exam (MMSE). The MMSE is a commonly used 30-point scale for assessing cognitive function in the areas of orientation, registration, attention and calculation, recall, language, and praxis.²³ MMSE administration was performed according to existing standards.²¹ The spelling of the word “world” backwards was used exclusively for the “Attention and Calculation” domain, as opposed to the alternative

HYPERTENSION STATUS

Comprehensive medical records since the time of facility admission were available for each participant. HTN status was obtained through the review of each participant's medical record by a geriatrician or licensed nurse with a geriatric specialization. A participant was considered hypertensive if he or she was admitted to the facility with an existing diagnosis of HTN, or a diagnosis was made upon, or after, admission. The HTN diagnostic criteria used was the American Heart Association

DATA ANALYSIS

Advanced age, female, nonwhite, and lower education have been shown to be associated with increased dementia risk.26, 27, 28 Therefore age, sex, race (Caucasian versus non-Caucasian), and years of education (continuous for descriptive purposes and trichotomized to <8, 8–12, and >12 for the mixed regression models described later) were used as covariates due to their known associations with cognitive performance and impairment.

Table 1 presents descriptive statistics for the study sample. For the

RESULTS

Of the 224 participants (Table 1), 134 had a diagnosis of HTN (59.82%; mean age = 84.35 [SD: ±7.8], mean years of education = 11.34 [SD: ±3.4]), and 90 were nonhypertensive (mean age = 85.71 [SD: ±7.26), mean years of education = 11.96 [SD: ±3.7]). The mean age of the entire sample was 84.89 (SD: ±7.6) at baseline, and the age range was 60.89–104.52. Mean education level was 11.59 years (SD: ± 3.5). The sample was stratified by CDR score at baseline and further subdivided into groups by HTN

CONCLUSIONS

For HTN participants with questionable dementia, the rate of cognitive decline was significantly more rapid relative to nonhypertensive participants, averaging 0.7824 points per year versus −0.7552 in non-HTN persons with questionable dementia. HTN status was not associated with rate of cognitive decline for participants with no dementia at initial baseline assessment, nor for participants with mild to severe dementia at baseline. These findings suggest that HTN is associated with increased

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Cited by (49)

An Unhealthy Plant-Based Diet Increases Risk of Hypertension but not Framingham Risk Score in Adults
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We investigated the relation of plant-based diets (PDs) with hypertension (HTN) and Framingham risk score (FRS) in Iranian adults.
We hypothesized that healthy PDs might have positive effects on blood pressure (BP) and FRS, whereas less-healthy plant-based foods might have negative effects.
The current cross-sectional study was performed on 527 middle-aged adults (45.7% women), who were selected through a multistage cluster random-sampling method. The assessment of dietary intakes was performed by using a validated food-frequency questionnaire. Twelve-hour fasting blood samples were collected to evaluate total cholesterol and high-density lipoprotein concentrations. BP was measured through the standard method and HTN was defined as BP ≥130/80 mmHg. FRS was used to predict the 10-y risk for development of cardiovascular disease (CVD).
The prevalence of HTN and high FRS among study participants were, respectively, 62% and 15.6%. After adjustment for potential confounders, plant-based diet index (PDI) and healthy plant-based diet index (hPDI) were not significantly associated with HTN [odds ratio (OR): 0.99; 95% confidence interval (CI): 0.55, 1.79 and OR: 0.83; 95% CI: 0.45, 1.53, respectively)]. However, those in the highest tertile of unhealthy plant-based diet index (uPDI) in comparison with those in the bottom tertile had a 100% increased odds of HTN (OR: 2.00; 95% CI: 1.04, 3.88). Greater adherence to PDI, hPDI, and uPDI was not related to high FRS chance, in fully adjusted model (OR: 0.50; 95% CI: 0.15, 1.65; OR: 1.03; 95% CI: 0.26, 4.04; and OR: 2.05; 95% CI: 0.56, 7.52, respectively).
This study demonstrated that less-healthy PDs would enhance the chance of HTN in Iranian adults, although PDIs were not significantly related to the 10-y risk of developing CVD.
Institutional and individual factors associated with functional outcomes in nursing home residents under long-term care insurance in Korea: A multilevel analysis
2023, Geriatric Nursing
The purpose of this study was to analyze the relationship between institutional and individual characteristics that influence changes in the functional outcomes of nursing home residents.
Long-term Care Insurance claims data with basic information of nursing home(n = 3,263) and long-term care needs assessment data of nursing home residents(n = 34,717) was used. The independent variable was classified into individual (level 1) and nursing home characteristics (level 2). Changes in physical function, cognitive function, and behavioral symptoms were used as dependent variables.
The institutional factors of nursing homes contributed relatively little to substantial changes in function of nursing home residents. Ownership, size, and nursing home staff including care worker and physical/occupational therapist were important determinants of functional changes in nursing home residents.
To improve the quality of nursing homes in Korea, regulations on staffing should be modified, and an disincentive policy should be introduced for low-quality institutions.
Rationale and methods for a multicenter clinical trial assessing exercise and intensive vascular risk reduction in preventing dementia (rrAD Study)
2019, Contemporary Clinical Trials
Citation Excerpt :
With paucity of pharmacologic treatment for age-related dementias, identification of potentially modifiable risk (or protective) factors and an understanding of the effect of modifying these factors on incidence and progression of dementia is pivotal [14–16]. The presence of cardiovascular risk factors such as hypertension, hypercholesterolemia, and physical inactivity in mid-to-late life is associated with cognitive decline [17–19] and increased risk of all-cause dementia [20–22]. Older adults are particularly affected by these risk factors, with >80% of older adults having one or more risk factors [23–25].
Alzheimer's Disease (AD) is an age-related disease with modifiable risk factors such as hypertension, hypercholesterolemia, obesity, and physical inactivity influencing the onset and progression. There is however, no direct evidence that reducing these risk factors prevents or slows AD. The Risk Reduction for Alzheimer's Disease (rrAD) trial is designed to study the independent and combined effects of intensive pharmacological control of blood pressure and cholesterol and exercise training on neurocognitive function. Six hundred and forty cognitively normal older adults age 60 to 85 years with hypertension and increased risk for dementia will be enrolled. Participants are randomized into one of four intervention group for two years: usual care, Intensive Reduction of Vascular Risk factors (IRVR) with blood pressure and cholesterol reduction, exercise training (EX), and IRVR+EX. Neurocognitive function is measured at baseline, 6, 12, 18, and 24 months; brain MRIs are obtained at baseline and 24 months. We hypothesize that both IRVR and EX will improve global cognitive function, while IRVR+EX will provide a greater benefit than either IRVR or EX alone. We also hypothesize that IRVR and EX will slow brain atrophy, improve brain structural and functional connectivity, and improve brain perfusion. Finally, we will explore the mechanisms by which study interventions impact neurocognition and brain. If rrAD interventions are shown to be safe, practical, and successful, our study will have a significant impact on reducing the risks of AD in older adults.
NCT Registration: NCT02913664
Current Medications for the Treatment of Alzheimer's Disease: Acetylcholinesterase Inhibitors and NMDA Receptor Antagonist
2017, Drug Discovery Approaches for the Treatment of Neurodegenerative Disorders: Alzheimer's Disease
Several drug options that provide limited effectiveness are used in conjunction with nonpharmacologic interventions to treat the declining cognitive status of a patient with Alzheimer’s disease along with the behavioral and psychological symptoms of dementia. Collaboration between patient, family, caregivers, and health care professionals is necessary with education on the disease course, an important early step along with the introduction of pharmacotherapy to treat cognitive and functional decline. Acetylcholinesterase inhibitors and N-methyl-d-aspartate glutamate receptor antagonist are approved by the Food and Drug Administration (FDA) to treat Alzheimer’s disease. Although current FDA-approved treatments offer no promise of cure or reversal of the disease, their use may improve health-related quality of life and delay placement of individual patients into institutional care.
The increased potassium intake improves cognitive performance and attenuates histopathological markers in a model of Alzheimer's disease
2015, Biochimica et Biophysica Acta - Molecular Basis of Disease
Citation Excerpt :
In fact, epidemiological studies have shown that hypertension leads to dementia and cognitive decline. However, the mechanism of this interaction is unclear [71–74]. One possible explanation of the interaction between hypertension and AD is that chronic hypertension leads to several pathological alterations, including effects on brain protein processing.
Alzheimer's disease (AD) is a neurodegenerative disorder characterized by hallmarks that include an accumulation of amyloid-β peptide (Aβ), inflammation, oxidative stress and synaptic dysfunction, which lead to a decrease in cognitive function. To date, the onset and progression of AD have been associated with pathologies such as hypertension and diabetes. Hypertension, a disease with a high incidence worldwide, is characterized by a chronic increase in blood pressure. Interestingly, this disease has a close relationship to the eating behavior of patients because high Na⁺ intake is a significant risk factor for hypertension. In fact, a decrease in Na⁺ consumption, along with an increase in K⁺ intake, is a primary non-pharmacological approach to preventing hypertension. In the present work, we examined whether an increase in K⁺ intake affects the expression of certain neuropathological markers or the cognitive performance of a murine model of AD. We observed that an increase in K⁺ intake leads to a change in the aggregation pattern of the Aβ peptide, a partial decrease in some epitopes of tau phosphorylation and improvement in the cognitive performance. The recovery in cognitive performance was correlated with a significant improvement in the generation of long-term potentiation. We also observed a decrease in markers related to inflammation and oxidative stress such as glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6) and 4-hydroxynonenal (4-HNE). Together, our data support the idea that changes in diet, such as an increase in K⁺ intake, may be important in the prevention of AD onset as a non-pharmacological therapy.
The Effects of Physical Activity on Experimental Models of Vascular Dementia: A Systematic Review and Meta-Analysis
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View all citing articles on Scopus

: This study was supported by NIA grant AG02219, Berkman Charitable Trust, and Dextra Baldwin McGonagle Foundation.

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Regular Research ArticlesHypertension is Associated With Cognitive Decline in Elderly People at High Risk for Dementia

Section snippets

OBJECTIVES

Participants

Mini Mental State Exam

HYPERTENSION STATUS

DATA ANALYSIS

RESULTS

CONCLUSIONS

Lancet

Lancet

J Clin Epidemiol

Neurobiol Aging

Lancet Neurol

J Psychiat Res

Neurobiology of Aging

Neurobiol Aging

Neurobiol Aging

Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study

Am J Epidemiol

Hypertension and the risk of mild cognitive impairment

Arch Neurol

Atherosclerosis and AD: analysis of data from the US National Alzheimer's Coordinating Center

Neurology

Volume cerebral blood flow reduction in pre-clinical stage of Alzheimer disease: evidence from an ultrasonographic study

J Neurol

Vascular factors in Alzheimer's disease

Int Psychogeriatr

Cardiac risk factors and potential treatments in Alzheimer's disease

Neurol Res

Hypertension and cognitive functioning among the elderly: an overview

Am J Ther

Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men

Hypertension

Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging

Neurology

The role of blood pressure in cognitive impairment in an elderly population. Osservatorio Geriatrico Campano Group

J Hypertens

Regular Research Articles
Hypertension is Associated With Cognitive Decline in Elderly People at High Risk for Dementia