I worry about dementia. My mother developed multi-infarct dementia (MID) at age 80 and experienced a 9-year decline and finally death with MID as the cause. My maternal grandmother also had a multi-year experience with dementia and died at age 95. My father's cognitive decline began at age 100, some months after having general anesthesia for a hip repair. He lived with dementia until he died at age 104. What are my chances and what can I do to prevent or delay what might be the inevitable?
In 2017, Walker et al1 published a review of research findings on blood pressure, cognitive decline, and dementia-confirming a relationship among these factors. Included among their findings are the following:
* Middle aged adults who have consistently experienced high blood pressure for 25 to 30 years are at "exceptional risk" for cognitive decline as they age.
* Chronic hypertension may cause a remodeling of the cerebral blood vessels promoting atherosclerosis and arteriosclerosis in large and small blood vessels, respectively. This remodeling may interfere in the supply of white and gray matter.
* Chronic hypertension may interfere with the brain's autoregulatory functions, thus reducing blood flow and the perfusion of cerebral tissue.
* Reduced blood flow as a function of hypertension may prevent the brain's regulation of the accumulation of tau, the protein implicated in Alzheimer disease, particularly the development of plaque and tangles.
* Alzheimer disease and vascular dementia (eg, MID) share overlapping pathophysiology in which hypertension is implicated.
* Although antihypertensives are widely used to control hypertension, the evidence is mixed with respect to benefit in late life.
Hypertension is a silent condition that can produce significant damage over time. Prolonged, undetected hypertension is highly correlated with cognitive decline in late life. Blood pressure, however, is a human variable that is easily monitored and sensitive to noninvasive, holistic interventions. In addition to eating a healthy diet and engaging in moderate exercise, I closely monitor my blood pressure to ensure that it is within healthy limits. Mindfulness-based stress reduction and other forms of meditation are also useful modalities in the control of blood pressure and in preventing associated cognitive decline.2 For yourself and your patients, determine your risk, regularly monitor your blood pressure, and use holistic measures to prevent cognitive decline.
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor-in-Chief
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