The following neuropathological indications may determine the coexistence of dementia and hypertension:
• in post-mortem examinations, the characteristics of previous stroke are found in 20-45% of cases of previously diagnosed dementia;
• about 13 people with dementia have changes in the white matter of the brain;
• in people with hypertension, the changes typical of Alzheimer's disease (-amyloid deposits, senile changes) occur 3-4 times more often than in people with normal pressure.
Brain microuders - accelerators of dementia
The asymptomatic period, which precedes the occurrence of overt dementia in many elderly people, may last for a long time and shortens the brain microarrays. The results of many studies support the hypothesis about the summation of these two processes: nun study, SYST-EUR study and Hénon's study, assessing the impact of cognitive decline on the risk of post-stroke dementia.
Treatment of hypertension relies on dementia
In three clinical trials, the relationship between dementia and hypertension was analyzed with the simultaneous quantitative analysis of cognitive functions of people participating in the study, which was one of the secondary assessment criteria used. The SYST-EUR clinical trial (Systolic hypertension in elderly in Europe) provided the first important arguments for the use of arterial hypotensive drugs. It can be concluded that increasing the number of tests will certainly explain the role of hypertension as a risk factor for the development of dementia, as well as Alzheimer's disease, and their results will provide additional justification for the treatment of hypertension in the elderly.
Evidence of the association of hypertension with strokes and brain damage
• In more than 13 people with hypertension in middle-aged people, there are micro-haemorrhage outbreaks, and magnetic resonance imaging shows signs of white matter damage.
• In people with hypertension and asymptomatic brain damage, there are:
- higher systolic pressure (accidental measurements or 24-hour measurement)
- higher flow pressure (24-hour measurement)
- increased vascular resistance of the cerebral arteries (24-hour measurement)
- remodeling within the cardiovascular system (hypertrophy of the left ventricle)
- early cognitive impairment (concentration and memory)
The facts quoted here are additional arguments for efficiently managing hypertension in old people.
The Honolulu study showed that an increase in systolic blood pressure by 10 mm Hg is accompanied by a 9% increase in the risk of cognitive impairment. In the Goeteborg study, the presence of any type of dementia was compared with mean arterial pressure values and it was found that the average pressure in patients over 70 years of age with dementia between 79 and 85 years was 178101 mm Hg, compared with 16492. mm Hg in people in this age group without the features of dementia.
Dementia in people with diabetes
Diabetes destroys the nervous system
In the situation of a growing epidemic of type II diabetes, it has been shown that in addition to the classic complications of this disease, its unfavorable effect on the functions of the central nervous system is more and more widely recognized.
Damage to the nervous system causes the growth of dementia
In the Epidemiology of Vascular Aging Study, in a 4-year follow-up, it was found that diabetes doubles the risk of developing dementia. As part of the Study of Osteoporotic Fractures program, during 4 years of observation of 10,000 women, diabetes increased the risk of cognitive impairment by 74%.Also at Atherosclerosis Risk in Communities (ARIC) Study, 11,000 people examined for 6 years have confirmed that diabetes is a risk factor for cognitive impairment.
Epidemiology of diabetes and dementia
It is shown that elderly diabetes is diagnosed in the UK by 10% of people of European descent and 16% of Indo-Asian people. 25% of residents of social care homes suffer from it. The increase in the number of patients in this age group results from the overlap of demographic trends, obesity and low physical activity. Dementia of various degrees can be found in up to 38% of patients with diabetes in the elderly.
Doctor of Medicine Janusz Krzyżowski
Psychiatrist
Private office tel. 22 833 18 68
00-774Warszawa, Dolna 4 lok. 15
