Does reducing blood pressure and cholesterol provide any HOPE for preventing cognitive decline and dementia?

Dementia is a rapidly increasing global clinical and public health issue in aging populations, and insights from observation and clinical assessment aided by pathology consistently suggest that modifying cardiovascular risk factors may prevent cognitive decline.¹ Such an approach was tested in the third Health Outcomes Prevention Evaluation (HOPE-3) trial,² as reported in this issue of Neurology®, in which an assessment of cognitive outcomes was included in an older subgroup (age ≥70 years) of 12,705 participants who had intermediate cardiovascular risk but had no prior cardiovascular events who were randomized to blood pressure (BP) lowering with a combination of candesartan and hydrochlorothiazide and cholesterol lowering with rosuvastatin. Of the initial 3,086 (24%) participants eligible for the cognitive substudy by age, 2,361 (77%) agreed to participate, and 1,626 (69%) were able to complete a series of tests emphasizing various aspects of cognitive function at baseline and at study end: the Digit Symbol Substitution Test (DSST), the modified Montreal Cognitive Assessment (mMoCA), and the Trail Making Test Part B (TMT-B). Despite reasonable reductions in systolic BP (by 6.0 mm Hg) and low-density lipoprotein cholesterol (LDL-C; 24.8 mg/dL) over a median of 5.7 years, there were no differences in any of the cognitive outcomes compared to placebo. However, in a post hoc analysis of the small group of participants (n = 181) at highest cardiovascular risk, defined by the highest tertiles of baseline systolic BP (>145 mm Hg) and LDL-C (>140 mg/dL), who were treated the most intensively with a combination of BP and cholesterol lowering, there was a reduction in cognitive decline on the DSST. What does this mean, and where do we go next?

from Neurology recent issues https://ift.tt/2HS2ZZ1

Comments

UPI: Kids with psych disorders most likely to take dangerous viral challenges

The “choking game” — and other clearly ill-advised and dangerous internet challenges — leave many parents wondering what drives teens to take the bait and participate. Now, a new study suggests that an underlying psychological disorder may be one reason why some kids jump at online dares such as the “Bird Box” challenge, where people walk around blindfolded, and the Tide Pod challenge, daring people to eat laundry detergent. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2DIWHbD

The emerging influential role of microglia in neurology

In her most catchily titled book, The Angel and the Assassin , Donna Jackson Nakazawa highlighed nerve cells which have hitherto been very little acknowledged – microglia . Long ignored as bit players in the big league of the nervous system, Nakazawa colourfully illustrated what many neuroscientists are beginning to realise: the small size of microglia belies their huge influence ; m icroglia are, after all, the defence force of the nervous system, protecting the brain from microbial invaders . In keeping with their small size, their role is to surreptitiously present the antigens of invading bugs to T cells , the toffs who actually carry out the final hatchet job . It is therefore not surprising that any dysfunction of microglia will come with significant clinical consequences . By GerryShaw – Own work , CC BY-SA 3.0 , Link The most important clinical fallout of dysfunctional microglia appears to be the emergence of dementia. It is indeed spec...

What are the pitfalls and perils of intracranial pressure?

Crudely speaking, the nervous system is made up of two parts. The peripheral nervous system , composed of nerves and muscles , is rather robust and roams free, exposed to the elements. On the other hand, the central nervous system , consisting of the brain and spinal cord , is delicate and fragile. It is therefore protectively cocooned in a rigid skull and a hardy vertebral skeleton . But even this tough fortress isn’t secure enough for these dainty neurones ; they are, after all, the command and control system for the whole body. Therefore, to further insulate them from the physical and physiological perturbations that continuously threaten them, nature has further sequestered them within a very exquisitely regulated irrigation system, the cerebrospinal fluid (CSF) . Internet Archive book Images on Flickr. https://www.flickr.com/photos/internetarchivebookimages/14769907251/ The CSF is actually a fine filtrate of the blood that flows in the arteries. The sieve is the very for...

NEURO

Search This Blog