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Yet another reason why you should keep your blood pressure in check.
Earlier this month, researchers shared how people can preserve brain health and memory skills as they age, and suggested that increased physical activity could play an important role. While you already know that exercise is important for your overall health, new follow-up research suggests an even more compelling reason to hit the gym—our brain health may be directly linked to blood pressure levels (which regular exercise can help lower).
The study found that those with a systolic blood pressure of 120 or lower were 19 percent less likely to develop cognitive issues—including memory loss and a decline in brain function, both precursors to dementia and Alzheimer's disease. Researchers came to this conclusion after studying 9,000 participants over the age of 50. The results—titled "Systolic Blood Pressure Intervention Trial (SPRINT)"—were published in the Journal of the American Medical Association.
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While lowering blood pressure has long been shown to benefit those facing cardiovascular health issues, this is the first time it's been shown to aid cognitive health as well. While the study found that participants were 17 percent less likely to develop dementia, the study wasn't long enough to suggest significant changes in the medical field. However, NBC reports that the Alzheimer's Association pledged an additional $800,000 for a follow-up trial with a timeline of at least two years longer than the first study.
More science news to read now:
Just last year, American health guidelines for healthy blood pressure levels were lowered to 130, so the study's target number is not too far off. Here’s the thing: focusing on lowering your blood pressure could help offset risk factors for heart disease, stroke, and kidney failure. Alzheimer's disease is also a major concern for Americans, as it's currently the sixth-leading cause of death, and nearly 6 million Americans have been diagnosed with the cognitive disease. By 2050, experts predict that more than 14 million will be affected by the disease, according to the Alzheimer's association.
"MCI is simply the earliest form of dementia,” Dr. Jeff Williamson, the study's lead author and gerontologist at the Wake Forest School of Medicine, told NBC News. “For anyone whose blood pressure is over 130, or looking to potentially prevent losing memory or thinking skills, this is something you can do.”
The bottom line: There's more research to be done before professionals will specifically target blood pressure in those suffering from dementia or other forms of cognitive decline. And doctors warn that the new study isn't substantial enough for the elderly to start upping their blood pressure medication without first consulting their healthcare professionals. But making an effort to stabilize your blood pressure levels through exercise and healthy eating will definitely aid in your overall health and longevity.
Tight blood pressure control can cut memory loss, study finds
Lowering blood pressure to recommended levels can prevent dementia and the memory and thinking problems that often show up first, researchers reported Wednesday.
People whose top blood pressure reading was taken down to 120 were 19 percent less likely to develop mild cognitive impairment, the loss of memory and brain processing power that usually precedes Alzheimer’s, the study found. And they were 15 percent less likely to eventually develop cognitive decline and dementia.
“This is really exciting,” said Heather Snyder, senior director of medical operations for the Alzheimer’s Association. The results were presented at the annual meeting of the association in Chicago.
Controlled with Medication
Lead researcher Dr. Rebecca Gottesman, an associate professor of neurology and epidemiology at Johns Hopkins University School of Medicine in Baltimore, did find that people whose blood pressure was controlled with medication had less mental decline than those with uncontrolled high blood pressure.
However, she stressed that because &ldquowe know how to treat high blood pressure,&rdquo bringing it under control might also cut a person&rsquos risk for dementia.
High blood pressure is usually the outcome of a poor diet and not enough exercise, but it can also be genetic. As people age, their blood pressure does usually change due to structural changes in the blood vessels. But the effects of aging on blood pressure can be reduced through daily exercise and a healthy diet.
The American Heart Association says that blood pressure should ideally be 120/80 mmHg or below. During the study, the average blood pressure was about 134/71 mmHg, which is considered pre-hypertensive. People with higher blood pressure across the study period tended to have more brain lesions, known as infarcts, which are areas of dead brain tissue that have lost their blood supply. Infarcts can lead to strokes, but many go undetected. People with higher blood pressure also showed more tau tangles, although they did not show significant differences in the other Alzheimer&rsquos feature, amyloid plaques. In fact, an increase in systolic pressure (the top blood pressure number) from 134 mmHg to 147 mmHg was linked to a 46% higher chance of having one or more brain infarcts.
&ldquoWe think that it&rsquos potentially biologically plausible that altered blood pressure later in life can cause infarcts [in the brain], given the body of literature in which we know that blood pressure is associated with stroke,&rdquo says Arvanitakis. She says the study does not show that high blood pressure actually causes brain lesions, and further research is needed to explore that connection.
The study provides more evidence that blood pressure may be one of the many factors that can contribute to aging brain processes, including the formation of lesions and hallmark features of diseases like Alzheimer&rsquos. Arvanitakis says she and her team plan to continue analyzing data from the participants to better understand how blood pressure affects the brain&mdashincluding, for example, whether those who lowered their blood pressure during the study were able to reduce the formation of infarcts. (Interestingly, people with extreme drops in blood pressure during the study also had a higher risk of more infarcts, likely because the decline represented other serious health issues.)
Most of the people in the study were taking medications to keep their blood pressure under control, but she notes that higher readings, even if they weren&rsquot excessively high, were associated with more brain lesions. &ldquoWe are not talking here about people with very high blood pressure,&rdquo she says. &ldquoWe&rsquore talking about pretty average blood pressure and what blood pressure across the whole range of readings can do to the brain.&rdquo
Until more research is done, Arvanitakis says the results should encourage people to focus on maintaining healthy blood pressure not just for their heart, but for brain health, as well. &ldquoMany, many issues are important for brain health and for avoiding brain diseases,” she says, “so we should consider them all in order to be as healthy as possible as we grow into the later stage of life.”
Lowering Your Blood Pressure Could Reduce Alzheimer’s Risk, New Research Shows
M argaret Daffodil Graham tries to live a healthy life, particularly since she has a health issue that requires constant attention. Like more than 100 million other Americans, the 74-year-old from Winston-Salem, N.C., has high blood pressure, and she has been taking medication to control it since she was in her 30s. So when she read that her nearby hospital, Wake Forest Baptist Medical Center, was looking for people with hypertension to volunteer for a study, she quickly signed up, knowing the doctors would monitor her blood pressure more intensively and hopefully lower her risk of developing heart disease and stroke.
What Graham didn’t realize was that by joining the trial, she wouldn’t just be benefiting her heart. The study, called SPRINT MIND, was designed to test whether aggressively lowering blood pressure would have an effect on people’s risk of cognitive decline, including symptoms of dementia related to Alzheimer’s disease.
Indeed, the trial’s results are now the first solid confirmation that lowering blood pressure reduces the risk of both mild cognitive impairment (MCI), a degree of brain decline that’s considered the gateway to dementia, and probable dementia. It was a revelation to Graham as well as others who volunteered. “It never occurred to me that controlling my blood pressure could protect me from dementia,” says Arthur Lane, 89, another participant in the study. “I think this is wonderful.”
Some 150 million people worldwide are expected to be affected by dementia by 2050. And while there are many ways people can change their behavior to lower their risk of heart disease and cancer–such as eating a healthy diet, exercising and avoiding or stopping smoking–there are few similar steps that have been scientifically proved to reduce the risk of degenerative brain disorders like Alzheimer’s. Genes play a prominent role in determining who will develop the disease, and age is also a major factor–neither of which are under human control.
That’s why Alzheimer’s experts have focused their attention on developing drug treatments for the disease. But these haven’t yielded any success thus far. In fact, in the past year, many major pharmaceutical companies have either stopped research on Alzheimer’s treatments after early studies of their drugs failed to show they were effective or decided to move away from developing treatments for neurodegenerative conditions altogether. “The data are pretty soft on a lot of things,” says Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center, “so that was discouraging for the field and discouraging for the general public.”
That may finally be changing. The study that Graham and Lane joined provides the strongest evidence yet that there may be something in people’s control that lowers their risk of cognitive decline. The results of the trial, which was funded by various agencies in the National Institutes of Health, were presented at the annual meeting of the Alzheimer’s Association in Chicago in July and immediately buoyed the hopes of Alzheimer’s experts. “It’s one of the first real demonstrations of a lifestyle modification having an impact on late-life cognition,” says Petersen, who was not involved in the study.
The SPRINT MIND study involved more than 9,300 elderly people who had had heart problems or were at higher risk of developing heart disease–some because they had high blood pressure, like Graham and Lane. They were randomly told to lower their blood pressure to either less than 120 mm Hg or 140 mm Hg systolic. (Current guidelines, revised in 2017 after the study began, now recommend that most people keep the upper number, or systolic pressure, under 130 mm Hg.) They were tested over an average of three years on various cognitive skills, including memory and processing of new information.
Biologically, it makes sense that blood pressure would affect dementia, says Dr. Jeff Williamson, chief of geriatric medicine at Wake Forest School of Medicine and the leader of the study. He compares having the right blood pressure to maintaining air pressure in a car’s tires–not too high, not too low. “Over time, high blood pressure can damage the walls of very fragile arteries that deliver blood to the brain and other organs,” he says. “And that can produce some of the things we see associated with dementia: inflammation and small strokes.”
After an average of three years, people who lowered their blood pressure to less than 120 mm Hg lowered their risk of developing MCI or probable dementia as measured by the tests by 15%, compared with people who lowered their blood pressure to 140 mm Hg.
“Controlling blood pressure is not only good for the heart but good for the brain,” says Williamson. “This is the first intervention of any kind that has proven in a randomized trial to reduce the risk of mild cognitive impairment.”
While the study only found a reduction in probable dementia, that doesn’t mean blood pressure can’t affect full-blown dementia. Because dementia takes longer to develop than MCI and the study followed people for only a relatively short period of time, more cases of advanced cognitive decline might not have been detected.
Still, it’s the first time that scientists have found something that can lower even MCI risk in a rigorous, randomized trial. “This provides great encouragement for people to say, Yes, make sure your blood pressure is well controlled, because right now, it’s one of the things you can do,” says Williamson. “This opens the door to testing more interventions.”
The trial’s results come on the heels of other evidence that controlling blood pressure may be an important weapon against cognitive decline. Another recent study, published in Neurology by researchers at the Rush Alzheimer’s Disease Center, found that people with higher blood pressure over a long period of time during their later years tended to have more brain lesions, or areas of dead brain tissue where nerve cells had lost their ability to communicate with one another. They also had more tangles of tau protein, another hallmark of Alzheimer’s that tends to appear later in the disease, which the researchers found when they performed autopsies on the participants.
“We wanted to look at actual changes in brain tissue that are affected by blood pressure,” says Dr. Zoe Arvanitakis, a professor of neurological sciences at Rush and one of the study’s authors. “Our results show that we need to do more research on how changes in blood pressure among the elderly relate to changes in cognitive function and dementia.”
That understanding could lead to treating Alzheimer’s as well as other dementias the same way that cancer and some infectious diseases are treated, with an array of therapies. Petersen, the Mayo Clinic researcher, for example, sees the latest blood-pressure study results as a step toward establishing treatments for Alzheimer’s that combine lifestyle changes and medication. With growing evidence that Alzheimer’s is caused by a multitude of factors, he believes treating the disease will likely require more than just effective drugs.
“There is almost certainly going to be combination therapy for Alzheimer’s down the road,” Petersen says. “And lowering blood pressure is part of the picture.”
Critical to making that happen are effective medications, and there are finally some promising drugs for Alzheimer’s that are now being tested. Unlike current drugs for the disease, which address only the symptoms of cognitive decline and not the root causes of Alzheimer’s, these could be the first to actually slow or even reverse the damage to brain nerves that cause memory loss, disorientation and other problems related to thinking skills. While trials of previous candidates have yielded mostly disappointing results, the latest studies on two drugs, BAN2401 and aducanumab, show they may shrink the amount of disease-causing protein plaques in the brain and could even slow the progression of cognitive decline (see sidebar, right).
Until these new drug treatments complete the final phases of testing, the SPRINT MIND study offers more immediate hope for battling dementia.
For Graham, the findings have reinforced her motivation to keep her blood pressure as low as possible. “I can deal with my body failing, but without your mind, there’s nothing,” she says. “So I do what I need to do to keep my body fit and hopefully not lose my mind.”
As part of her efforts, Graham takes long walks, does her own yard work in the summer and makes regular trips to a local YMCA to train with weights to maintain muscle strength. She is grateful that her contribution to the study means that more people may be able to avoid developing MCI or even dementia. “I can leave some type of legacy in this world,” she says.
Lane, who is retired, and his wife Diane are hoping that his participation in the study will inspire their family members to lower their blood pressure–especially their two children who have hypertension. “I guarantee you this will be a discussion that we have with all of our children,” says Diane. Having a way to control their future risk of dementia, she says, “puts the ball back in our court.”
Treat Blood Pressure, Lower Dementia Risk
All of the men took part in the Honolulu-Asia Aging Study. Of the 774 men, 610 had high blood pressure or were being treated for high blood pressure. Among about 350 who had been treated, 15% received a beta-blocker, 18% received a beta-blocker plus one or more other medications, and the rest received other blood pressure drugs.
All types of blood pressure medications seemed to have a positive effect on the risk of dementia, the study shows.
Researchers led by Lon White, MD, of the Pacific Health Research and Education Institute in Honolulu, Hawaii, performed autopsies on the brains of these men. They looked for brain lesions indicating Alzheimer’s disease and microinfarcts, scars left behind most likely from unrecognized mini-strokes.
Men who had received beta-blockers alone showed fewer brain abnormalities than those who had not been treated for high blood pressure or who had received other blood pressure drugs. Study participants who had taken beta-blockers alone or in combination with another blood pressure medication showed less shrinkage in their brains.
Dementia and Health
Age and age-related health problems such as stroke, heart disease, high blood pressure, and diabetes are among the most commonly recognized risk factors for the onset of Alzheimer’s. But according to the study, the various health conditions listed in the frailty index also appear to be at play in the development of the disease.
“We evaluated several health deficits that are not known to be risks for dementia, and found that, combined in an index variable, they were significantly associated not just with survival, but also with the incidence of [Alzheimer's disease] and dementia of all types over 5-year and 10-year intervals,” the authors write. “Accumulating any health deficit seemingly remote to dementia increases the risk of dementia by over 3%.”
That leads the authors of the study, published today in the online edition of the journal Neurology, to conclude that maintaining overall health could play a significant role in keeping Alzheimer’s and other forms of dementia at bay.
“Our study suggests that rather than just paying attention to already known risk factors for dementia, such as diabetes or heart disease, keeping up with your general health may help reduce the risk for dementia,” study co-author Kenneth Rockwood, MD, of Dalhousie University in Halifax, Nova Scotia, Canada, says in a news release.
What Can You Do to Lower Your Risk of Alzheimer’s Disease?
How can I prevent Alzheimer’s? Are there any treatments out there for people who already have it?
“Those are the two things people want to know,” says P. Murali Doraiswamy, director of the Neurocognitive Disorders Program at Duke University School of Medicine, and co-author of “The Alzheimer’s Action Plan.”
Alzheimer’s, the most common form of dementia, affects 6.2 million Americans 65 and older. It is one of the most feared diseases and also one of the most elusive in terms of treatment and cure.
On Monday, the Food and Drug Administration approved the first Alzheimer’s drug in nearly two decades, Biogen’s aducanumab, which will be sold under the brand name Aduhelm. The approval of the drug came after years of research and doubts over its effectiveness.
The approval is “a positive step in the right direction,” says Dr. Doraiswamy. It’s important, though, that clinicians and patients temper their expectations, he says, noting that not everyone with Alzheimer’s disease qualifies, and the benefits and effects are not “dramatic.”
P. Murali Doraiswamy, at Duke University School of Medicine, is a leading Alzheimer’s researcher.
Although the progressive brain disease has been difficult to fight, Dr. Doraiswamy is optimistic about advances in a variety of areas. Blood tests to detect Alzheimer’s at a doctor’s office are being developed and some home-based digital cognitive tools for tracking and possibly treating it have cleared the FDA. Researchers are finding ways to use sophisticated brain scans to detect Alzheimer’s-related proteins and have also identified how the seemingly unrelated condition of hearing loss is linked to higher risk of Alzheimer’s.
“I think it’s a hopeful time,” Dr. Doraiswamy says.
In this edited interview, he discusses promising tools for detecting Alzheimer’s, steps you can take to reduce risk, misconceptions about the disease and the impact of Covid-19 on dementia.
How do you tell the difference between memory issues in normal aging as opposed to Alzheimer’s and other dementias?
If you can’t remember what you forget, you have a problem. All of us forget stuff but it usually comes back a few hours later or when not so stressed or trying. Second is that it gets worse over time. Normal age-related memory loss usually doesn’t get substantially worse over time. Also with Alzheimer’s, cues rarely help. If you give other people a cue, they remember or give the right answer.
And while all of us have trouble learning new information and take a while to figure out a smart TV, Alzheimer’s patients find it impossible to use a new microwave or remote.
What are the most promising developments in detecting Alzheimer’s and treating mild memory problems?
Simple blood tests that appear to have reasonable diagnostic and predictive value. Instead of running a two-hour battery of tests or ordering complicated brain scans that cost thousands of dollars, a simple blood test can be done at a primary-care doctor’s office. They haven’t been approved by the FDA for routine clinical practice, but we are very close, and I expect within the next two years we will have several tests that can do that.
Also there are a number of digital-based cognitive tests. Some are free memory surveys and self-tests that anyone can take at home that provide a memory score, but require some expertise to interpret. One, the Self-Administered Gerocognitive Exam, includes simple math problems, a questionnaire and a drawing test. Some other digital-based cognitive tests, which have been cleared by the FDA, require a prescription and are used in memory assessments. One FDA-cleared test includes a series of brain games to assess five cognitive domains, including attention, working and episodic memory.
In the future, they could be coupled with digital therapeutics. So if you found that your memory, reaction time or concentration is weak, you would play specific sets of computerized cognitive games to strengthen those skills. These digital therapeutics have been approved for conditions such as ADHD and I see no reason why they can’t be available in the next year or so for treating mild memory problems.
What are some of the advances in brain research?
One big development is something called “Alzheimer’s in a Dish.” They’ve been able to form mini Alzheimer’s brains, with plaques and tangles, in a petri dish by using neurons from patients. That work was done at Massachusetts General Hospital and is a very big advance because you will be able to see if a drug works quickly. They can screen hundreds or thousands of drugs in months, compared to a more costly, time-consuming process using mice.
What are some preventive measures people can take on their own?
Diet. People on vegetarian or Mediterranean diets have cleaner brains in regards to Alzheimer’s pathology than those who eat a diet rich in saturated fat. A vegetarian diet has been associated with reduced amyloid pathology in the brain. Reducing vascular risks, controlling blood pressure, cholesterol, diabetes, weight—all of those have been shown to reduce your risk for developing dementia. Be mentally and socially active.
Hearing loss may be one of the biggest potentially reversible factors for Alzheimer’s risk. Studies have shown that if you have hearing loss for a long period, it causes shrinkage of brain regions that are very close to the memory centers. So hearing aids and regular hearing tests are very important.
What about sleep?
We know that sleep is when the brain boosts our immunity and archives our memories. We know that sleep is important for clearing toxic proteins from the brain. All those are crucial. So yes, it is important to get a good night’s rest for a healthy memory.
Much of the treatment and therapies seems to be targeted for those in the early stages. What about those in the middle or later stages?
We have medications on the market that treat symptoms of those in the middle stages, but we haven’t found anything to fix the damage in the brain once it has occurred. That is why there is so much urgency to develop preventive strategies.
SHARE YOUR THOUGHTS
Has Alzheimer’s touched your life and in what way? Join the conversation below.
What impact has the pandemic had on Alzheimer’s patients?
It prevented Alzheimer’s patients from getting proper care during the last 12-15 months. More people with Alzheimer’s died during the pandemic than with any other disease. There are some studies that have suggested there is an increased incidence of dementia among Covid survivors. We may end up with a new term, Covid dementia.
The research on Covid vaccine technology has really given a boost to the field in terms of rapid mobilization of resources and working with regulatory agencies. I’m hoping that will spill over into other fields, like ours.
What prevents people from getting tested?
Fear. Alzheimer’s is the most feared disease, even more so than cancer. People fear losing their independence, their identity and having to give up everything, from driving to managing their accounts. But a lot of patients who are diagnosed and in early stages can still drive and manage. It requires coordinated family planning around it to see what can and can’t be done.
Others think that it’s not worth getting evaluated because nothing can be done about it. But if you don’t get evaluated, you don’t know if it’s Alzheimer’s or something else. I had a patient who thought he had Alzheimer’s but it turned out to be a severe vitamin deficiency. We corrected it, and his cognition was back to normal.
It’s also important for people to get tested so they can make plans, including financial ones.
What do you do personally to keep your brain healthy?
I’m an academic. It helps that every day I’m doing challenging stuff from morning to night. I play tennis and exercise. I spend a lot of time socializing. I like chess and bridge. An occasional glass of wine 2-3 days a week. I’m a vegetarian, so I don’t have to worry about high saturated fat-related plaque build-up.
What do you expect to see in 10 years?
I think technology and brain science will be tightly integrated. I think we will have incredible tools to image the brain and detect early stages of disease pathology with a drop of blood.
We will probably have very sophisticated smartphone-based sensors and wearables that can predict the onset of Alzheimer’s.
I hope we will have a vaccine to prevent Alzheimer’s in 10 years, but it remains to be seen.
Write to Clare Ansberry at [email protected]
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Appeared in the June 8, 2021, print edition as 'How to Lower Alzheimer’s Risk.'
High Blood Pressure Linked with Higher Risk of Dementia: Previous Study
A previous study which we reported on set out to answer the question of whether there was a difference between systolic blood pressure and diastolic blood pressure in terms of the associated increase in the risk of dementia later in life.
Systolic blood pressure is the measurement of the pressure in your blood vessels when your heart is beating. Diastolic blood pressure measures the pressure in the blood vessels when the heart is resting. The current study also measured the effects of age on these blood pressure measurements over a follow-up period of 30 years.
The study consisted of 6,895 men and 3,413 women, aged 35&ndash55 at the outset of the study. The participants&rsquo blood pressure measurements were taken in a sitting position, after five minutes of resting. Both systolic and diastolic blood pressure was measured twice at each follow-up. The status of patients&rsquo dementia was analyzed by using the data from three national health databases.
The results of the study reaffirmed the hypothesis that hypertension in middle age was related to the development of dementia later in life, but that hypertension later in life was unrelated to the development of dementia. The risk of dementia increased with prolonged hypertension in middle age, but it did not seem to affect the age at which patients were diagnosed with dementia.
We all know the importance of maintaining healthy blood pressure levels when it comes to protecting our heart health. These two studies show the added benefit that lower blood pressure can have on our brain health.
How can I control my blood pressure?
There are things you can do to lower your blood pressure if it is too high. One way is through a series of lifestyle changes that include losing weight, exercising regularly, maintaining a healthy diet that is low in salt, reducing caffeine and alcohol consumption, and quitting smoking. Alternatively, high blood pressure can be controlled through the use of blood pressure medication, which is prescribed by your doctor. These blood pressure lowering drugs have been shown to be safe and effective. However it is important to note that they have not been proven or recommended to directly prevent vascular dementia. There is a great deal of research into finding potential therapies that may be able to slow down or prevent development of vascular dementia.
If you have high blood pressure, it is important to talk to your doctor before attempting any lifestyle changes or trying new medication so they can provide you with personalised recommendations and monitor your progress.
A key take away message from these longitudinal research studies is that a life-long approach to health is important. Keeping blood pressure levels normal is only one factor, along with exercise, diet, smoking, and alcohol consumption that is important to consider when attempting minimising your risk of developing dementia. High blood pressure does not give you any symptoms initially so it is important to be proactive and find out what your blood pressure is.