US Pharm. 2018;43(11):1.

Older adults may be able to modify an important dementia risk factor—stiffness of the aorta—through medication and lifestyle changes, according to recent research. This finding by scientists from the University of Pittsburgh, which suggests that geriatric patients can lower their risk for dementia, exerts an even greater effect than blood-pressure reduction.

Drawing on data gleaned from following hundreds of elderly Pittsburgh residents for more than 15 years, the study was reported in the Journal of Alzheimer’s Disease. Arterial stiffness, the research revealed, is a strong predictor of dementia development than even subclinical brain disease. Because arterial stiffness can be lessened by antihypertensive medications and probably lifestyle interventions, the findings suggest that at-risk patients may have the power to prevent or delay the onset of dementia.

“As the large arteries get stiffer, their ability to cushion the pumping of blood from the heart is diminished, and that transmits increased pulsing force to the brain, which contributes to silent brain damage that increases dementia risk,” said senior author Rachel Mackey, PhD, MPH, assistant professor of epidemiology, University of Pittsburgh Graduate School of Public Health.

The authors examined the link between arterial stiffness and dementia among 356 older adults with an average age of 78 years. At the study’s onset in 1988, all of the participants were dementia free. Dr. Mackey and her team tested their aortic stiffness with pulse wave velocity (PWV), which noninvasively measures the speed at which blood moves through arteries. Study participants also received MRI brain scans to ascertain signs of subclinical brain disease.

Compared with those with lower PWV values, subjects with high PWV readings, the scientists found, were 60% more likely to develop dementia during the following 15 years. Even though arterial stiffness is correlated with subclinical brain disease and risk factors for cardiovascular disease, these confounding variables did not explain the results.

“It’s very surprising that adjusting for subclinical brain disease markers didn’t reduce the association between arterial stiffness and dementia at all,” said Chendi Cui, MS, first author on the paper and doctoral student at Pitt Public Health. “We expect that arterial stiffness increases the risk of dementia partly by increasing subclinical brain damage. However, in these older adults, arterial stiffness and subclinical brain damage markers appeared to be independently related to dementia risk.”

According to Dr. Mackey, the apparent strong association between arterial stiffness and dementia in advanced age suggests that “even at age 70 or 80, we might still be able to delay or prevent the onset of dementia.”

Learn how cognitive deterioration may lead to dementia or Alzheimer’s disease in this issue’s continuing education article (page 36), “Mild Cognitive Impairment Overview and Update,” by Tina Caliendo, PharmD, BCGP, BCACP, and Olga Hilas, PharmD, MPH, BCPS, BCGP, FASHP.

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