Managing Your High Blood Pressure Can Reduce Your Dementia Risk, Says New Study
Dementia is a common brain disorder that affects over 55 million people worldwide, including over 7 million Americans. However, that number is expected to rise. According to the Population Reference Bureau," as the large baby boomer population ages, the total number of people with dementia will rise. Estimates vary, but experts report more than 7 million people aged 65 or older had dementia in 2020. If current demographic and health trends continue, more than 9 million Americans could have dementia by 2030 and nearly 12 million by 2040."
Dementia is not a disease, but rather a general term for wide-ranging neurological symptoms. There's many types of dementia, with Alzheimer's disease being the most common. It's a debilitating condition that can rob you of cognitive functions like memory, language and the ability to make decisions. It can become so severe that it disrupts daily life and in some cases a caregiver is needed. While it mostly affects people over 65, it's not a normal part of aging and someone younger can also develop the syndrome, although it's rare.
While there's no cure or surefire way to prevent dementia, there are ways to reduce the risk including treating high blood pressure, according to a new study. Eat This, Not That! Health spoke with Dr. J. Wes Ulm, Harvard and MIT-trained MD, PhD with a background in bioinformatics, gene therapy, genetics, drug discovery, consulting and education who was not affiliated with the study, but explains the findings of the research and what to know about the data. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.
What to Know About Dementia
Dr. Ulm tells us, 'Dementia' is an umbrella classifier for an array of neurological disorders with steadily rising incidence and prevalence – that is, annual reported cases and total aggregate case numbers, respectively, in the population – within the United States and globally. Alongside the well-known and common diagnosis of Alzheimer's dementia, these include vascular dementia, Dementia with Lewy Bodies (DLB), frontotemporal dementia (FTD a.k.a. Pick's Disease), and a variety of rarer subtypes including the dementia presentations ensuing from Huntington's Disease, Creutzfeldt-Jakob Disease (CJD), Progressive Supranuclear Palsy (PSP), and Corticobasal Syndrome (CBS). There are also comparatively treatable forms of dementia resulting from conditions such as Vitamin B12 deficiency, normal pressure hydrocephalus (NPH), alcoholism, and post-traumatic stress disorder (PTSD), as well as dementias attributed to viral causes such as HAND (HIV-associated neurocognitive disorder), with mounting concern about COVID-19 potentially leading in this direction.
The term itself derives from a Latin root for "forgetting," and as the etymology suggests, a common hallmark of dementia disorders is memory loss and impairment, particularly of faculties of short-term and working memory. This is demonstrated most tellingly in Alzheimer's disease, named after a German doctor whose monographs vividly described the disease's onset and progression in Auguste Deter, one of his patients. With that said, the specific clinical presentations and onset patterns of different dementia diagnoses can be quite diverse. Although incidence tends to increase with age for most subtypes, some can present more commonly in younger patients. This is especially true of FTD, for which memory loss is actually one of the later-presenting symptoms."
Why Managing Blood Pressure Is Important for Dementia, According to the Study
Dr. Ulm explains, "While the specific physiological mechanisms are still being unpacked, it has long been recognized that improved cardiovascular health manifests a solid association with decreased dementia risk. For instance vascular dementia, the second most frequently diagnosed subtype, arises on the heels of the cumulative damage from ischemic strokes and transient ischemic attacks i.e. TIAs (both resulting from clots in blood vessels supplying the brain, which can obstruct the local circulation).
The risk factors for this form of dementia, therefore, can clearly be productively addressed with better management of cardiovascular risk factors — including the elevated blood pressure in hypertensive patients — but it turns out that other forms of dementia may also be mitigated in frequency and severity with such interventions, including Alzheimer's disease. For this reason, as shown by the study, improved patient compliance with blood pressure medication can also tangibly reduce the risk of a range of dementia diagnoses."
How the Study was Conducted
The study's co-author Ruth Peters, an associate professor at the University of New South Wales in Australia told CNN "What is so exciting about our study is that the data shows that those people who were taking the blood pressure lowering medication had a lower risk of a dementia diagnosis than those taking a matching placebo."
So how was the study conducted? According to CNN, the research, "combined data from five large randomized, double-blinded clinical trials of more than 28,000 older adults with an average age of 69 from 20 countries. All had a history of hypertension. Each of the clinical trials compared people taking blood pressure medications with people taking a matching placebo pill and followed them for an average of 4.3 years. Pooling the data, Peters and her team found that a drop of about 10 mm/Hg on the systolic and 4 mm/Hg on the diastolic blood pressure readings at 12 months significantly lowered the risk of a dementia diagnosis."
Why Researchers Believed There Was a Connection Between Dementia and Blood Pressure
Dr. Ulm says, "Physicians and medical researchers have long been aware that good cardiovascular and general health are associated with reduced dementia risk, not only for vascular dementia but also for other forms as well. This observation is, furthermore, consistent with what we know from the pathogenesis patterns — essentially the causes and onset features — of the various dementia subtypes, which are multifactorial (and variable among the different forms) but likely to be exacerbated by the cumulative harm from inadequate blood flow or oxygenation to the hard-working tissues of the central nervous system.
It is therefore logical to hypothesize that poorly managed blood pressure in hypertensive patients — a known risk factor for heart disease and damage to the interior lining (endothelium) of systemic blood vessels — might also be associated with elevated dementia risk. Conversely, more rigorous management of blood pressure through anti-hypertensive medication would be expected to alleviate this risk, a hypothesis addressed and investigated by this study."
Lifestyle Choices Can Help Reduce the Risk
Dr. Ulm states, "While genetic factors have been implicated in the diseases' onset — most notably the well-documented association of the ε4 allele of apolipoprotein E with Alzheimer's — there is a solid body of evidence suggesting that the development and severity of dementia symptoms are at least somewhat modifiable by lifestyle, nutritional, and general health factors. There are mixed indications that some cognitively challenging pursuits — such as crossword puzzles and sudoku — may have a salutary effect (though this remains under debate), with much stronger evidence for the dementia-abating potential of learning one or more foreign languages, particularly to the point of fluency. However, a growing raft of studies also point to the relevance of overall health maintenance and a healthy constitution in mitigating or warding off dementia, particularly with respect to exercise, diet, and cardiovascular health, including the potential role of tighter blood pressure control, in patients with hypertension (high blood pressure), in diminishing the risk."
The Centers for Disease Control and Prevention says, "Modifiable risk factors are the lifestyle and behaviors that can reduce or increase a person's chances of developing a disease. For example, there are modifiable risk factors that could reduce your risk of Alzheimer's disease and related dementias (ADRD), slow its progression, or increase your risk of ADRD. Most modifiable risk factors for ADRD are related to cardiovascular disease and other chronic health conditions. They include hypertension, not getting enough physical exercise, obesity, diabetes, depression, smoking, hearing loss, and binge drinking. Maintaining a healthy lifestyle and managing related chronic conditions is good for your overall physical health, facilitates and improves brain health, and may help decrease the risk of dementia or slow its progression."
Wes Ulm, MD, PhD, is a physician-researcher, musician (J. Wes Ulm and Kant's Konundrum) ,and novelist, and earned a dual MD/PhD degree from Harvard Medical School and MIT. He is part of the Heroes of the COVID Crisis series in relation to his ongoing efforts in the drug discovery and public health arena.