scholarly journals Impact of mean blood pressure and blood pressure variability after diagnosis of mild cognitive impairment and risk of dementia

2021 ◽  
Author(s):  
Adam de Havenon ◽  
Varsha Muddasani ◽  
Mohammad Anadani ◽  
Shyam Prabhakaran
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Blood Pressure Variability ◽  
Mean Blood Pressure

scholarly journals Increased Blood Pressure Variability and the Risk of Probable Dementia or Mild Cognitive Impairment: A Post Hoc Analysis of the SPRINT MIND Trial

2021 ◽  
Author(s):  
Adam de Havenon ◽  
Mohammad Anadani ◽  
Shyam Prabhakaran ◽  
Ka‐Ho Wong ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Systolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Pressure Control ◽  
Post Hoc Analysis ◽  
The Mean ◽  
Post Hoc

Background Increased systolic blood pressure variability (BPV) is associated with stroke, cardiovascular disease, and dementia and mild cognitive impairment. However, prior studies assessing the relationship between BPV and dementia or mild cognitive impairment had infrequent measurement of blood pressure or suboptimal blood pressure control. Methods and Results We performed a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) MIND (Memory and Cognition in Decreased Hypertension) trial. The primary outcome was probable dementia during follow‐up. We defined our exposure period, during which blood pressures were collected, as the first 600 days of the trial, and outcomes were ascertained during the subsequent follow‐up. BPV was measured as tertiles of systolic blood pressure standard deviation. We fit Cox proportional hazards models to our outcome. We included 8379 patients. The mean follow‐up was 3.2±1.4 years, during which 316 (3.8%) patients developed dementia. The mean number of blood pressure measurements was 7.8, and in the tertiles of BPV, the SD was 6.3±1.6, 10.3±1.1, and 16.3±3.6 mm Hg, respectively. The rate of dementia was 2.4%, 3.6%, and 5.4% by ascending tertile, respectively ( P <0.001). In the Cox models, compared with the lowest tertile of BPV, the highest tertile of BPV increased the risk of dementia in both unadjusted (hazard ratio [HR], 2.36; 95% CI, 1.77–3.15) and adjusted (HR, 1.69; 95% CI, 1.25–2.28) models. Conclusions In a post hoc analysis of the SPRINT MIND trial, we found that higher BPV was associated with the development of probable dementia despite excellent blood pressure control. Additional research is needed to understand how to reduce BPV and if its reduction lowers the risk of cognitive impairment and dementia.

scholarly journals Long-Term Blood Pressure Variability Across the Clinical and Biomarker Spectrum of Alzheimer’s Disease

2020 ◽  
Vol 77 (4) ◽  
pp. 1655-1669
Author(s):  
Isabel J. Sible ◽  
Daniel A. Nation ◽  
Keyword(s):  
Alzheimer’S Disease ◽  
Blood Pressure ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Systolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Cognitively Normal ◽  
Systolic Blood Pressure Variability

Background: Elevated blood pressure is linked to cognitive impairment and Alzheimer’s disease (AD) biomarker abnormality. However, blood pressure levels vary over time. Less is known about the role of long-term blood pressure variability in cognitive impairment and AD pathophysiology. Objective: Determine whether long-term blood pressure variability is elevated across the clinical and biomarker spectrum of AD. Methods: Alzheimer’s Disease Neuroimaging Initiative participants (cognitively normal, mild cognitive impairment, AD [n = 1,421]) underwent baseline exam, including blood pressure measurement at 0, 6, and 12 months. A subset (n = 318) underwent baseline lumbar puncture to determine cerebrospinal fluid amyloid-β and phosphorylated tau levels. Clinical groups and biomarker-confirmed AD groups were compared on blood pressure variability over 12 months. Results: Systolic blood pressure variability was elevated in clinically diagnosed AD dementia (VIM: F2,1195 = 6.657, p = 0.001, η2 = 0.01) compared to cognitively normal participants (p = 0.001), and in mild cognitive impairment relative to cognitively normal participants (p = 0.01). Findings were maintained in biomarker-confirmed AD (VIM: F2,850 = 5.216, p = 0.006, η2 = 0.01), such that systolic blood pressure variability was elevated in biomarker-confirmed dementia due to AD relative to cognitively normal participants (p = 0.005) and in biomarker-confirmed mild cognitive impairment due to AD compared to cognitively normal participants (p = 0.04). Conclusion: Long-term systolic blood pressure variability is elevated in cognitive impairment due to AD. Blood pressure variability may represent an understudied aspect of vascular dysfunction in AD with potential clinical implications.

scholarly journals Feasibility of 3-month melatonin supplementation for brain oxidative stress and sleep in mild cognitive impairment: protocol for a randomised, placebo-controlled study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041500
Author(s):  
Zoe Menczel Schrire ◽  
Craig L Phillips ◽  
Shantel L Duffy ◽  
Nathaniel S Marshall ◽  
Loren Mowszowski ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Blood Pressure ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Feasibility Trial ◽  
Controlled Study ◽  
Brain Oxidative Stress ◽  
Randomised Controlled

IntroductionMelatonin has multiple proposed therapeutic benefits including antioxidant properties, synchronisation of the circadian system and lowering of blood pressure. In this protocol, we outline a randomised controlled trial to assess the feasibility, acceptability and tolerability of higher dose (25 mg) melatonin to target brain oxidative stress and sleep disturbance in older adults with mild cognitive impairment (MCI).Methods and analysisThe study design is a randomised double-blind, placebo-controlled, parallel group trial. Forty individuals with MCI will be recruited from the Healthy Brain Ageing Clinic, University of Sydney and from the community, and randomised to receive either 25 mg oral melatonin or placebo nightly for 12 weeks. The primary outcomes are feasibility of recruitment, acceptability of intervention and adherence to trial medication at 12 weeks. Secondary outcomes will include the effect of melatonin on brain oxidative stress as measured by magnetic resonance spectroscopy, blood pressure, blood biomarkers, mood, cognition and sleep. Outcomes will be collected at 6 and 12 weeks. The results of this feasibility trial will inform a future conclusive randomised controlled trial to specifically test the efficacy of melatonin on modifiable risk factors of dementia, as well as cognition and brain function. This will be the first trial to investigate the effect of melatonin in the population with MCI in this way, with the future aim of using this approach to reduce progression to dementia.Ethics and disseminationThis protocol has been approved by the Sydney Local Health District Ethics Committee (X18-0077). This randomised controlled trial will be conducted in compliance with the protocol published in the registry, the International Conference for Harmonisation on Good Clinical Practice and all other applicable regulatory requirements. The findings of the trial will be disseminated via conferences, publications and media, as applicable. Participants will be informed of results of the study at the conclusion of the trial. Eligible authors will include investigators who are involved in the conception and design of the study, the conduct of the trial, the analysis of the results, and reporting and presentation of study findings.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ANZCTRN 12619000876190).Protocol versionV.8 15 October 2020.

scholarly journals RESTING STATE NETWORK AND MINDFULNESS IN MOTION PLUS DASH DIET IN AFRICAN AMERICANS WITH MILD COGNITIVE IMPAIRMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S112-S113
Author(s):  
Kathy D Wright ◽  
Klatt Maryanna ◽  
Ingrid Adams ◽  
Cady Block ◽  
Todd Monroe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Pilot Study ◽  
African Americans ◽  
Resting State ◽  
Mindfulness Practice ◽  
Control Group ◽  
Breathing Exercises ◽  
Resting State Network

Abstract The resting state network (RSN) is a target of interest in neurodegenerative research, with evidence linking functional connectivity of its constituent nodes with mild cognitive impairment and dementia. Given the emerging linkage between Alzheimer’s disease and related dementia disorders (ADRD) and hypertension (HTN), non-pharmacological interventions that promote RSN connectivity and blood pressure are needed. The purpose of this pilot study protocol is to deliver a novel intervention, combining mindfulness and the Dietary Approaches to Stop Hypertension (DASH), to improve RSN connectivity and blood pressure in African American (AA) older adults with MCI and HTN. Thirty-six AAs aged 65 and older will be randomized to mindfulness plus DASH, attention control (non-health related education), or a control group. The Mindfulness in Motion (MIM) plus DASH intervention is delivered in 8-weekly group sessions of 6-10 participants. MIM includes mindful movements from chair/standing, breathing exercises and guided meditation. The DASH intervention uses a critical thinking approach that involves problem solving, goal setting, reflection, and developing self-efficacy. Both components are culturally tailored for older African Americans. Cognitive examination, diet and mindfulness practice surveys, blood pressure, and functional magnetic resonance imaging (RSN) data are collected at baseline and 3 months. Forty-eight AAs were screened and 17 were enrolled (women= 13; men= 4) to date. Of the 17 enrolled, 7 were eligible for neuroimaging. Findings from this pilot study may provide the preliminary evidence that MIM plus DASH may improve RSN connectivity and blood pressure in this population at risk for ADRD.

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