Is Hypertension a Cause of Dementia in the Elderly? : A Clinico-Pathological Study

Abstract

To elucidate whether hypertension can be a cause of dementia in the elderly, and, if so, what mechanisms are involved in, a clinicopathological analysis was performed in 109 consecutive necropsied patients aged over 65 years. The diagnosis of vascular dementia was established in 17 cases, of which 11 showed leuko-araiosis (L-A) on CT scans and six did not. Of the 17 cases with vascular dementia and 71 nondemented cases, the pathological findings for the brain in 40 cases with L-A were compared with 48 cases without L-A, and those in 11 demented cases with L-A with those in 29 nondemented cases with L-A. Statistical analysis revealed that hypertensive changes of the intracerebral arteries (such as fibrinoid necrosis), lacunes, arteriosclerosis of subcortical white matter arteries, atherosclerosis of Willis circle, and cerebral amyloid angiopathy-associated vasculopathy (CAA-AV) were significantly more frequently found in the cases with L-A than in the cases without L-A. Among the cases with L-A, the incidence of hypertensive changes of the intracerebral arteries and lacunes was significantly higher in those with dementia than in those without. These results suggest that effects of hypertension on small parenchymal arteries and on cerebral atherosclerosis play important roles in the occurrence of L-A, and that the presence of lacunes is an important factor in the development of dementia. Although the proportion of cases with CAA-AV was small, L-A was thought to be caused by CAA-AV independently from the hypertensive and atherosclerotic processes. Senile changes are also suggested to play some role in the development of vascular dementia. (Hypertens Res 1994; 17 Suppl. I: S97-S101)