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Is neurocardiovascular instability a risk factor for cognitive decline and/or dementia? The science to date

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  01 August 2007

Orla Collins  and
Rose Anne Kenny
Orla Collins
Affiliation:
St James's Hospital, Dublin 8, Ireland
Rose Anne Kenny*
Affiliation:
St James's Hospital, Dublin 8, Ireland
*
Address for correspondence: Professor R A Kenny, Department of Medical Gerontology, Trinity College Health Sciences Building, St James's Hospital, Dublin 8, Ireland.
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Extract

Neurocardiovascular instability (NCVI) is defined as ‘age-related changes in blood pressure and heart-rate behaviour, predominantly resulting in hypotension and bradyarrhythmia’ The four most common presentations of NCVI are orthostatic hypotension (OH), carotid sinus hypersensitivity/syndrome (CSH/CSS), vasovagal syncope (VVS) and post-prandial hypotension (PPH), although there is considerable overlap between these conditions. The criteria for diagnosis of these syndromes are given in Table 1. Clinically, these conditions manifest as dizziness, falls, pre-syncope and syncope. Older people are more susceptible to NCVI because of age-related physiological changes in the cardiovascular system, the autonomic nervous system, and humoral control of blood pressure. These neurocardiovascular changes are further complicated by co-morbidity and polypharmacy in older people.

Type
Biological gerontology
Information
Reviews in Clinical Gerontology , Volume 17 , Issue 3 , August 2007 , pp. 153 - 160
Copyright
Copyright © Cambridge University Press 2008

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References

1Kenny, RA, Kalaria, R, Ballard, C. Neurocardiovascular instability in cognitive impairment and dementia. Ann N Y Acad Sci 2002; 977: 183–95.CrossRefGoogle ScholarPubMed
2Ballard, C, Shaw, F, McKeith, I, Kenny, R. High prevalence of neurovascular instability in neurodegenerative dementias. Neurology 1998; 51: 1760–62.CrossRefGoogle ScholarPubMed
3Kenny, RA, Shaw, FE, O'Brien, JT, Scheltens, PH, Kalaria, R, Ballard, C. Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions. J Neurol Neurosurg Psychiatry 2004; 75: 966–71.CrossRefGoogle ScholarPubMed
4Miller, VM, Kenny, RA, Slade, JY, Oakley, AE, Kalaria, RN. Medullary autonomic pathology in carotid sinus hypersensitivity. Neuropathol Appl Neurobiol 2007.CrossRefGoogle Scholar
5Allan, LM, Ballard, CG, Allen, J et al. Autonomic dysfunction in dementia. J Neurol Neurosurg Psychiatry 2007; 78: 671–77.CrossRefGoogle ScholarPubMed
6de la Torre, JC. Is Alzheimer's disease a neurodegenerative or a vascular disorder? Data, dogma, and dialectics. Lancet Neurol 2004; 3: 184–90.CrossRefGoogle ScholarPubMed
7Duschek, S, Matthias, E, Schandry, R. Essential hypotension is accompanied by deficits in attention and working memory. Behav Med 2005; 30: 149–58.CrossRefGoogle ScholarPubMed
8Launer, LJ, Masaki, K, Petrovitch, H, Foley, D, Havlik, RJ. The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA 1995; 274: 1846–51.CrossRefGoogle ScholarPubMed
9Guo, Z, Fratiglioni, L, Winblad, B, Viitanen, 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; 145: 1106–13.CrossRefGoogle ScholarPubMed
10Pandav, R, Dodge, HH, DeKosky, ST, Ganguli, M. Blood pressure and cognitive impairment in India and the United States: a cross-national epidemiological study. Arch Neurol 2003; 60: 1123–28.CrossRefGoogle ScholarPubMed
11Kahonen-Vare, M, Brunni-Hakala, S, Lindroos, M, Pitkala, K, Strandberg, T, Tilvis, R. Left ventricular hypertrophy and blood pressure as predictors of cognitive decline in old age. Aging Clin Exp Res 2004; 16: 147–52.CrossRefGoogle ScholarPubMed
12Glynn, RJ, Beckett, LA, Hebert, LE, Morris, MC, Scherr, PA, Evans, DA. Current and remote blood pressure and cognitive decline. JAMA 1999; 281: 438–45.CrossRefGoogle ScholarPubMed
13Bohannon, AD, Fillenbaum, GG, Pieper, CF, Hanlon, JT, Blazer, DG. Relationship of race/ethnicity and blood pressure to change in cognitive function. J Am Geriatr Soc 2002; 50: 424–29.CrossRefGoogle Scholar
14Guo, Z, Viitanen, M, Winblad, B. Clinical correlates of low blood pressure in very old people: the importance of cognitive impairment. J Am Geriatr Soc 1997; 45: 701–05.CrossRefGoogle ScholarPubMed
15Guo, Z, Viitanen, M, Fratiglioni, L, Winblad, B. Low blood pressure and dementia in elderly people: the Kungsholmen project. BMJ 1996; 312 (7034):805–8.CrossRefGoogle ScholarPubMed
16Morris, MC, Scherr, PA, Hebert, LE et al. The cross-sectional association between blood pressure and Alzheimer's disease in a biracial community population of older persons. J Gerontol A Biol Sci Med Sci 2000; 55: M130–36.CrossRefGoogle Scholar
17Petitti, DB, Buckwalter, JG, Crooks, VC, Chiu, V. Prevalence of dementia in users of hormone replacement therapy as defined by prescription data. J Gerontol A Biol Sci Med Sci 2002; 57: M532–38.CrossRefGoogle ScholarPubMed
18Kokmen, E, Beard, CM, Chandra, V, Offord, KP, Schoenberg, BS, Ballard, DJ. Clinical risk factors for Alzheimer's disease: a population-based case-control study. Neurology 1991; 41: 1393–97.CrossRefGoogle ScholarPubMed
19Rockwood, K, Lindsay, J, McDowell, I. High blood pressure and dementia. Lancet 1996; 348 (9019):65; author reply 65–66.CrossRefGoogle ScholarPubMed
20Ueda, K, Kawano, H, Hasuo, Y, Fujishima, M. Prevalence and etiology of dementia in a Japanese community. Stroke 1992; 23: 798–803.CrossRefGoogle Scholar
21Ruitenberg, A, Skoog, I, Ott, A et al. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study. Dement Geriatr Cogn Disord 2001; 12: 33–39.CrossRefGoogle ScholarPubMed
22Morris, MC, Scherr, PA, Hebert, LE, Glynn, RJ, Bennett, DA, Evans, DA. Association of incident Alzheimer disease and blood pressure measured from 13 years before to 2 years after diagnosis in a large community study. Arch Neurol 2001; 58 (10):1640–6.CrossRefGoogle Scholar
23Verghese, J, Lipton, RB, Hall, CB, Kuslansky, G, Katz, MJ. Low blood pressure and the risk of dementia in very old individuals. Neurology 2003; 61: 1667–72.CrossRefGoogle ScholarPubMed
24Qiu, C, von Strauss, E, Fastbom, J, Winblad, B, Fratiglioni, L. Low blood pressure and risk of dementia in the Kungsholmen project: a 6-year follow-up study. Arch Neurol 2003; 60: 223–28.CrossRefGoogle Scholar
25Qiu, C, Winblad, B, Fastbom, J, Fratiglioni, L. Combined effects of APOE genotype, blood pressure, and antihypertensive drug use on incident AD. Neurology 2003; 61: 655–60.CrossRefGoogle ScholarPubMed
26Qiu, C, Winblad, B, Fratiglioni, L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol 2005; 4:487–99.CrossRefGoogle ScholarPubMed
27Kilander, L, Nyman, H, Boberg, M, Hansson, L, Lithell, H. Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension 1998; 31: 780–86.CrossRefGoogle ScholarPubMed
28Elias, MF, Wolf, PA, D'Agostino, RB, Cobb, J, White, LR. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol 1993; 138: 353–64.CrossRefGoogle ScholarPubMed
29Swan, GE, DeCarli, C, Miller, BL et al. Association of midlife blood pressure to late-life cognitive decline and brain morphology. Neurology 1998; 51: 986–93.CrossRefGoogle ScholarPubMed
30Swan, GE, Carmelli, D, Larue, A. Systolic blood pressure tracking over 25 to 30 years and cognitive performance in older adults. Stroke 1998; 29: 2334–40.CrossRefGoogle ScholarPubMed
31Kilander, L, Nyman, H, Boberg, M, Lithell, H. The association between low diastolic blood pressure in middle age and cognitive function in old age. A population-based study. Age Ageing 2000; 29: 243–48.CrossRefGoogle ScholarPubMed
32Elias, PK, Elias, MF, Robbins, MA, Budge, MM. Blood pressure-related cognitive decline: does age make a difference? Hypertension 2004; 44: 631–36.CrossRefGoogle Scholar
33Carmelli, D, Swan, GE, Reed, T et al. Midlife cardiovascular risk factors, ApoE, and cognitive decline in elderly male twins. Neurology 1998; 50: 1580–85.CrossRefGoogle ScholarPubMed
34Kivipelto, M, Helkala, EL, Hanninen, T et al. Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Neurology 2001; 56: 1683–89.CrossRefGoogle ScholarPubMed
35Wu, C, Zhou, D, Wen, C, Zhang, L, Como, P, Qiao, Y. Relationship between blood pressure and Alzheimer's disease in Linxian County. China. Life Sci 2003; 72: 1125–33.CrossRefGoogle ScholarPubMed
36Launer, LJ, Ross, GW, Petrovitch, H et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000; 21: 49–55.CrossRefGoogle ScholarPubMed
37Petrovitch, H, White, LR, Izmirilian, G et al. Midlife blood pressure and neuritic plaques, neurofibrillary tangles, and brain weight at death: the HAAS. Honolulu-Asia aging Study. Neurobiol Aging 2000; 21: 57–62.Google ScholarPubMed
38Korf, ES, White, LR, Scheltens, P, Launer, LJ. Midlife blood pressure and the risk of hippocampal atrophy: the Honolulu Asia Aging Study. Hypertension 2004; 44:29–34.CrossRefGoogle ScholarPubMed
39Kivipelto, M, Helkala, EL, Laakso, MP et al. Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population-based study. BMJ 2001; 322 (7300):1447–51.CrossRefGoogle ScholarPubMed
40Whitmer, RA, Sidney, S, Selby, J, Johnston, SC, Yaffe, K. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology 2005; 64: 277–81.CrossRefGoogle ScholarPubMed
41Yamada, M, Kasagi, F, Sasaki, H, Masunari, N, Mimori, Y, Suzuki, G. Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study. J Am Geriatr Soc 2003; 51: 410–14.CrossRefGoogle ScholarPubMed
42Winblad, B, Palmer, K, Kivipelto, M et al. Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004; 256: 240–46.CrossRefGoogle Scholar
43Mathias, CJ, Kimber, JR. Postural hypotension: causes, clinical features, investigation, and management. Annu Rev Med 1999; 50: 317–36.CrossRefGoogle ScholarPubMed
44Elmstahl, S, Rosen, I. Postural hypotension and EEG variables predict cognitive decline: results from a 5-year follow-up of healthy elderly women. Dement Geriatr Cogn Disord 1997; 8: 180–87.CrossRefGoogle ScholarPubMed
45Viramo, P, Luukinen, H, Koski, K, Laippala, P, Sulkava, R, Kivela, SL. Orthostatic hypotension and cognitive decline in older people. J Am Geriatr Soc 1999; 47: 600–04.CrossRefGoogle ScholarPubMed
46Passant, U, Warkentin, S, Gustafson, L. Orthostatic hypotension and low blood pressure in organic dementia: a study of prevalence and related clinical characteristics. Int J Geriatr Psychiatry 1997; 12: 395–403.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
47Benarroch, EE, Schmeichel, AM, Low, PA, Boeve, BF, Sandroni, P, Parisi, JE. Involvement of medullary regions controlling sympathetic output in Lewy body disease. Brain 2005; 128: 338–44.CrossRefGoogle ScholarPubMed
48Andersson, M, Hansson, O, Minthon, L, Ballard, CG, Londos, E. The period of hypotension following orthostatic challenge is prolonged in dementia with Lewy bodies. Int J Geriatr Psychiatry 2008; 23: 192–98.CrossRefGoogle ScholarPubMed
49McKeith, IG, Dickson, DW, Lowe, J et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005; 65: 1863–72.CrossRefGoogle ScholarPubMed
50Emre, M. Dementia associated with Parkinson's disease. Lancet Neurol 2003; 2: 229–37.CrossRefGoogle ScholarPubMed
51Allcock, LM, Kenny, RA, Mosimann, UP et al. Orthostatic hypotension in Parkinson's disease: association with cognitive decline? Int J Geriatr Psychiatry 2006; 21: 778–83.CrossRefGoogle ScholarPubMed
52Braak, H, Ghebremedhin, E, Rub, U, Bratzke, H, Del Tredici, K. Stages in the development of Parkinson's disease-related pathology. Cell Tissue Res 2004; 318: 121–34.CrossRefGoogle ScholarPubMed
53Chaudhuri, KR. Autonomic dysfunction in movement disorders. Curr Opin Neurol 2001; 14: 505–11.CrossRefGoogle ScholarPubMed
54Braak, H, Braak, E. Diagnostic criteria for neuropathologic assessment of Alzheimer's disease. Neurobiol Aging 1997; 18 (4 suppl):S85–8.CrossRefGoogle ScholarPubMed
55Novak, V, Novak, P, Spies, JM, Low, PA. Autoregulation of cerebral blood flow in orthostatic hypotension. Stroke 1998; 29:104–11.CrossRefGoogle ScholarPubMed
56Passant, U, Warkentin, S, Minthon, L, Faldt, R, Edvinsson, L. Cortical blood flow during head-up postural change in subjects with orthostatic hypotension. Clin Auton Res 1993; 3: 311–18.CrossRefGoogle ScholarPubMed
57Ballard, C, O'Brien, J, Barber, B et al. Neurocardiovascular instability, hypotensive episodes, and MRI lesions in neurodegenerative dementia. Ann N Y Acad Sci 2000; 903: 442–45.CrossRefGoogle ScholarPubMed
58Bordier, P, Colsy, M, Robert, F, Bourenane, G. Prevalence of positive carotid sinus massage and related risk of syncope in patients with Alzheimer's disease. Europace 2007; 9: 829–34.CrossRefGoogle ScholarPubMed
59Wood, BH, Bilclough, JA, Bowron, A, Walker, RW. Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study. J Neurol Neurosurg. Psychiatry 2002; 72: 721–25.CrossRefGoogle ScholarPubMed
60Kenny, RA, Richardson, DA, Steen, N, Bexton, RS, Shaw, FE, Bond, J. Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: 1491–46.CrossRefGoogle ScholarPubMed
61Crilley, JG, Herd, B, Khurana, CS et al. Permanent cardiac pacing in elderly patients with recurrent falls, dizziness and syncope, and a hypersensitive cardioinhibitory reflex. Postgrad Med J 1997; 73 (861):415–18.CrossRefGoogle Scholar
62Parry, SW, Steen, N, Baptist, M, Fiaschi, KA, Parry, O, Kenny, RA. Cerebral autoregulation is impaired in cardioinhibitory carotid sinus syndrome. Heart 2006; 92: 792–97.CrossRefGoogle ScholarPubMed