Occurrence and Progression of Dementia in a Community Population Aged 75 Years and Older: Relationship of Antihypertensive Medication Use | Dementia and Cognitive Impairment | JAMA Neurology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.153.100.128. Please contact the publisher to request reinstatement.
1.
Skoog  INilsson  LPalmertz  BAndreasson  LASvanborg  A A population-based study of dementia in 85-year-olds.  N Engl J Med. 1993;328153- 158Google ScholarCrossref
2.
O'Brien  MD How does cerebrovascular disease cause dementia?  Dementia. 1994;5133- 136Google Scholar
3.
Forette  FBoller  F Hypertension and the risk of dementia in the elderly.  Am J Med. 1991;90(suppl 3A)14S- 19SGoogle ScholarCrossref
4.
Hachinski  V Preventable senility: a call for action against the vascular dementias.  Lancet. 1992;340645- 648Google ScholarCrossref
5.
Scheinberg  P Dementia due to vascular disease: a multifactorial disorder.  Stroke. 1988;191291- 1299Google ScholarCrossref
6.
Gorelick  PB Status of risk factors for dementia associated with stroke.  Stroke. 1997;28459- 463Google ScholarCrossref
7.
Roman  GC Senile dementia of the Binswanger type: a vascular form of dementia in the elderly.  JAMA. 1987;2581782- 1788Google ScholarCrossref
8.
Guo  ZViitanen  MFratiglioni  LWinblad  B Blood pressure and dementia in the elderly: epidemiologic perspectives.  Biomed Pharmacother. 1997;5168- 73Google ScholarCrossref
9.
Geldmacher  DSWhitehouse  PJ Evaluation of dementia.  N Engl J Med. 1996;335330- 336Google ScholarCrossref
10.
Yoshitake  TKiyohara  YKato  I  et al.  Incidence and risk factors of vascular dementia and Alzheimer's disease in a defined elderly Japanese population: the Hisayama Study.  Neurology. 1995;451161- 1168Google ScholarCrossref
11.
Skoog  ILernfelt  BLandahl  S  et al.  15-Year longitudinal study of blood pressure and dementia.  Lancet. 1996;3471141- 1145Google ScholarCrossref
12.
Snowdon  DAGreiner  LHMortimer  JARiley  KPGreiner  PAMarkesbery  WR Brain infarction and the clinical expression of Alzheimer's disease: the Nun Study.  JAMA. 1997;277813- 817Google ScholarCrossref
13.
Olichney  JMHansen  LAHofstetter  CRGrundman  MKatzman  RThal  LJ Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension.  Arch Neurol. 1995;52702- 708Google ScholarCrossref
14.
Viitanen  MGuo  Z Are cognitive function and blood pressure related?  Drugs Aging. 1997;11165- 169Google ScholarCrossref
15.
Prince  MJBird  ASBlizard  RAMann  AH Is the cognitive function of older patients affected by antihypertensive treatment? results from 54 months of the Medical Research Council's trial of hypertension in older adults.  BMJ. 1996;312801- 805Google ScholarCrossref
16.
Applegate  WBPressel  SWittes  J  et al.  Impact of the treatment of isolated systolic hypertension on behavioral variables: results from the Systolic Hypertension in the Elderly Program.  Arch Intern Med. 1994;1542154- 2160Google ScholarCrossref
17.
Fratiglioni  LViitanen  MBäckman  LSandman  POWinblad  B Occurrence of dementia in advanced age: the study design of the Kungsholmen Project.  Neuroepidemiology. 1992;1129- 36Google ScholarCrossref
18.
Folstein  MFFolstein  SEMcHugh  PR "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician.  J Psychiatr Res. 1975;12189- 198Google ScholarCrossref
19.
Fratiglioni  LGrut  MForsell  Y  et al.  Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education.  Neurology. 1991;411886- 1892Google ScholarCrossref
20.
Fratiglioni  LViitanen  Mvon Strauss  ETontodonati  VHerlitz  AWinblad  B Very old women at highest risk of dementia and Alzheimer's disease: incidence data from the Kungsholmen Project, Stockholm.  Neurology. 1997;48132- 138Google ScholarCrossref
21.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition.  Washington, DC American Psychiatric Association1987;
22.
Hughes  CPBerg  LDanziger  WLCoben  LAMartin  RL A new clinical scale for the staging of dementia.  Br J Psychiatry. 1982;140566- 572Google ScholarCrossref
23.
Forsell  YFratiglioni  LGrut  MViitanen  MWinblad  B Clinical staging of dementia in a population survey: comparison of DSM-III-R and the Washington University Clinical Dementia Rating Scale.  Acta Psychiatr Scand. 1992;8649- 54Google ScholarCrossref
24.
Wills  PFastbom  JClaesson  CBCornelius  CThorslund  MWinblad  B Use of cardiovascular drugs in an older Swedish population.  J Am Geriatr Soc. 1996;4454- 60Google Scholar
25.
Nordic Council on Medicines, Guidelines for ATC Classification [in Swedish].  Uppsala, Sweden Nordic Council on Medicines1985;NLN publication 16.
26.
Guo  ZFratiglioni  LWinblad  BViitanen  M Blood pressure and performance on the Mini-Mental State Examination in the very old: cross-sectional and longitudinal data from the Kungsholmen Project.  Am J Epidemiol. 1997;1451106- 1113Google ScholarCrossref
27.
Korn  ELGraubard  BIMidthune  D Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale.  Am J Epidemiol. 1997;14572- 80Google ScholarCrossref
28.
Davis  KL Future therapeutic approaches to Alzheimer's disease.  J Clin Psychiatry. 1998;59(suppl 11)14- 16Google ScholarCrossref
29.
Kaplan  NMGifford  RW  Jr Choice of initial therapy for hypertension.  JAMA. 1996;2751577- 1580Google ScholarCrossref
30.
Psaty  BMSmith  NLSiscovick  DS  et al.  Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis.  JAMA. 1997;277739- 745Google ScholarCrossref
31.
Pantoni  LGarcia  JH The significance of cerebral white matter abnormalities 100 years after Binswanger's report: a review.  Stroke. 1995;261293- 1301Google ScholarCrossref
32.
Sparks  DLScheff  WLiu  H  et al.  Increased incidence of neurofibrillary tangles (NFT) in non-demented individuals with hypertension.  J Neurol Sci. 1995;131162- 169Google ScholarCrossref
33.
Kalaria  R Cerebral vessels in aging and Alzheimer's disease.  Pharmacol Ther. 1996;72193- 214Google ScholarCrossref
34.
Thomas  TThomas  GMcLendon  CSutton  TMullan  M β-Amyloid-mediated vasoactivity and vascular endothelial damage.  Nature. 1996;380168- 171Google ScholarCrossref
35.
Rosenberg  RN A causal role for amyloid in Alzheimer's disease: the ending of the beginning.  Neurology. 1993;43851- 856Google ScholarCrossref
36.
Selkoe  DJ Amyloid beta-protein and the genetics of Alzheimer's disease.  J Biol Chem. 1996;27118295- 18298Google ScholarCrossref
37.
Suo  ZFang  CCrawford  FMullan  M Superoxide free radical and intracellular calcium mediate A β1-42 induced endothelial toxicity.  Brain Res. 1997;762144- 152Google ScholarCrossref
38.
Kool  MJLustermans  FABreed  JG  et al.  The influence of perindopril and the diuretic combination amiloride+hydrochlorothiazide on the vessel wall properties of large arteries in hypertensive patients.  J Hypertens. 1995;13839- 848Google ScholarCrossref
39.
Kähönen  MMäkynen  HArvola  PWuorela  HPörsti  I Arterial function after trichlormethiazide therapy in spontaneously hypertensive rats.  J Pharmacol Exp Ther. 1995;2721223- 1230Google Scholar
40.
Abrahams  ZTan  LLYPang  MYMAbrahams  BTan  MMWright  JM Demonstration of an in vitro direct vascular relaxant effect of diuretics in the presence of plasma.  J Hypertens. 1996;14381- 388Google ScholarCrossref
41.
Guo  ZViitanen  MFratiglioni  LWinblad  B Low blood pressure and dementia in elderly people: the Kungsholmen Project.  BMJ. 1996;312805- 808Google ScholarCrossref
42.
Hogan  DBEbly  EMRockwood  K Weight, blood pressure, osmolarity, and glucose levels across various stages of Alzheimer's disease and vascular dementia.  Dement Geriatr Cogn Disord. 1997;8147- 151Google ScholarCrossref
Original Contribution
August 1999

Occurrence and Progression of Dementia in a Community Population Aged 75 Years and Older: Relationship of Antihypertensive Medication Use

Author Affiliations

From the Department of Geriatric Medicine, Karolinska Institute and Stockholm Gerontology Research Center, Stockholm, Sweden.

Arch Neurol. 1999;56(8):991-996. doi:10.1001/archneur.56.8.991
Abstract

Objective  To examine whether antihypertensive medication use can affect the occurrence and progression of dementia.

Subjects and Methods  In a community cohort of 1810 persons aged 75 years and older, 225 prevalent cases of dementia were detected. Among the 1301 persons without dementia, 224 incident cases of dementia were identified during an average period of 3 years. Among the 225 prevalent cases of dementia, 79 were suitable for the analysis of cognitive decline. Information on drug use was collected for the 2 weeks preceding the baseline interview.

Results  Subjects taking antihypertensive medication (n=651, 83.9% of whom took diuretics) had a lower prevalence of dementia than those not taking antihypertensive medication (P<.001). Subjects without dementia who were taking antihypertensive medication at baseline (n=584) had a reduced incidence of dementia (adjusted relative risk, 0.7; 95% confidence interval, 0.6-1.0; P=.03). Furthermore, subjects taking diuretics (n=484) had an adjusted relative risk of 0.7 (95% confidence interval, 0.5-1.0; P=.02) for all dementia, and subjects taking diuretic monotherapy (n=345) had an adjusted relative risk of 0.6 (95% confidence interval, 0.4-0.9; P=.006). The use of other antihypertensive medication (calcium antagonists or β-blockers), however, was related to a reduced risk of Alzheimer disease (adjusted relative risk, 0.6; 95% confidence interval, 0.3-1.2) only in the subpopulation with a higher baseline blood pressure (n=458). Patients with dementia at baseline who were not taking diuretics had a 2-fold faster rate of decline in the score on the Mini-Mental State Examination than those taking diuretics.

Conclusion  The use of diuretics may protect against dementia in elderly persons.

×