Epidemiologic Insights Into Blood Pressure and Cognitive Disorders

Abstract

In this chapter we discuss issues related to cognitive disorders and elevated levels of blood pressure from mid-life and older. The classification of at-risk levels of elevated blood pressure and prevalence of elevated levels is described. Elevated blood pressure levels and their contribution to late-life cognitive disorders are then discussed from the perspective of vascular disease and neurodegeneration. Elevated blood pressure levels lead to damage to large, small and micro vessels in the brain, which in turn have been shown to lead to poorer performance on cognitive tests. Similarly associations of markers of neurodegeneration, such as total brain volume and Alzheimer’s neuropathologic lesions have also been associated with elevated blood pressure levels. There are several hypothesized pathways through which elevated blood pressure levels can lead to both cognitively-adverse vascular and neurodegenerative events. Specific trials of anti-hypertensive medications to prevent cognitive impairment have not yielded consistent data supporting the use of BP control to reduce the occurrence of cognitive disorders. However, a more long-term perspective on the issue is needed.