“The Role of Hypertension and Cholesterol in Dementia: Prevention and Treatment Strategies”

2023-05-11 08:22:00

Destruction of the white matter region responsible for cognitive function… leading to Alzheimer’s disease

Cholesterol accumulation in the intima of blood vessels… Aging of dementia as brain tissue necrosis

Hypertension is a risk factor for both Alzheimer’s disease and vascular dementia, and hypertension in middle age adversely affects cognitive function in later life.

Dementia is largely divided into vascular dementia and Alzheimer’s disease. Vascular dementia refers to a case of cognitive impairment as a result of a stroke. The main cause of dementia is vascular disease, especially high blood pressure. Cholesterol builds up on the inner lining of blood vessels, narrowing and clogging them, increasing the risk of high blood pressure or stroke. In particular, when blood vessels in the brain are blocked or burst, oxygen is not supplied to brain cells, leading to necrosis of brain tissue and dementia.

The American Heart Association (AHA) warned that “high blood pressure is a risk factor for both Alzheimer’s disease and vascular dementia, and high blood pressure in middle age adversely affects cognitive function in later life.” It is said that high blood pressure causes problems in the brain blood vessels and damages the white matter area in charge of cognitive function, leading to Alzheimer’s disease.

Alzheimer’s disease involves proteins called ‘beta amyloid’ and ‘tau’. When beta amyloid is made excessively and accumulates in the brain, tau protein, which forms the skeleton of brain cells, begins to become entangled. As a result, the nerve cells in the brain, called neurons, die, and brain function deteriorates rapidly. At this time, beta amyloid protein builds up slowly over 15 to 25 years, eventually causing problems in the brain.

Vascular dementia occurs when the cerebral arteries that supply blood to the brain become hardened and the blood supply decreases, and it usually occurs after a stroke. In particular, hypertension is known to increase the risk of vascular dementia. The World Health Organization (WHO) is holding hypertension management as a guideline for dementia prevention.

As a result of multiple regression analysis (statistical analysis) on data from 28,008 hypertensive patients, a research team from the University of New South Wales (UNSW) in Australia found that lowering systolic blood pressure by 10 mmHg and diastolic blood pressure by 4 mmHg lowered the risk of developing dementia by 13%. . When comparing the risk of developing dementia in patients who had been treated for hypertension for an average of 4.3 years and in the placebo group, the risk of developing dementia in the systolic blood pressure group below 147 mmHg, between 147 and 167 mmHg, and above 167 mmHg was 23%, respectively. , 18% and 7% lower.

In particular, the effect of hypertension treatment in lowering the risk of dementia was found to be greater when the patient was younger. Therefore, in order to escape from the risk of dementia, it was pointed out that management should be started sooner.

Cognitive function deteriorates rapidly if hypertension is not adequately dealt with. At the American Heart Association Hypertension Conference, a study was announced that high blood pressure in middle-aged and elderly people accelerates the decline in cognitive function, and that treatment of hypertension can slow down the speed of cognitive function decline. Columbia University analyzed data from more than 11,000 people, and among participants aged 55 or older and blood pressures of 140/90 mmHg or higher, those who were not treated for high blood pressure experienced a faster decline in cognitive function than those who were treated for high blood pressure.

In order to lower blood pressure, it is fundamentally necessary to identify the cause of cholesterol that blocks blood vessels and increases blood pressure. Cholesterol is thought to be caused by food, but in fact, only 20% of it is introduced into food. The remaining 80% is synthesized and exported as cholesterol to create cell membranes in the liver or to treat inflammation. When inflammation occurs in the body, cholesterol is produced for treatment, so if inflammation is not properly resolved, cholesterol also increases and accumulates, clogging blood vessels and causing high blood pressure. Therefore, in order to prevent blood vessels from being clogged with cholesterol, reducing inflammation should be a priority.

If cholesterol is not managed properly and blood vessels are blocked, oxygen and nutrients cannot be properly supplied to brain cells, resulting in damage to brain tissue. In the worst case, when a cerebral infarction or cerebral hemorrhage occurs, brain cells lose their function and lead to dementia. High blood pressure and cholesterol increase beta amyloid protein, which has been pointed out as the cause of Alzheimer’s disease.

In recent years, studies have shown that HDL cholesterol, called good cholesterol, inhibits the production of beta-amyloid. A number of studies have shown that a decrease in HDL cholesterol levels affects cognitive decline.

HDL cholesterol releases bad cholesterol and plaque accumulated in the inner lining of blood vessels out of the body and keeps the blood vessels wide and elastic. It travels around the blood vessels in the brain and removes unnecessary cholesterol, while also removing beta-amyloid, which is the cause of dementia.

The Alzheimer’s Disease Research Center at UC Davis investigated cholesterol levels and measured brain deposition of beta-amyloid in 74 patients with normal or mild cognitive impairment. As a result, it was found that subjects with high levels of bad cholesterol (LDL cholesterol) and low levels of good cholesterol (HDL cholesterol) also had high levels of amyloid in the brain.

At the Korean Heart Association Fall Conference held last year, Severance Hospital’s team led by Professor Lee Chan-joo analyzed data from about 1.5 million people using data from the National Health Insurance Corporation. As a result, the higher the cholesterol level, the higher the incidence of dementia.

That is, the incidence of dementia in patients with severe hypercholesterolemia with an LDL cholesterol level (normal of 130 mg/dL or less) of 190 to 224 mg/dL was 1.12 times higher than that of the control group (less than 160 mg/dL). The incidence of dementia was 1.34 times higher. The risk of developing Alzheimer’s disease was also 1.13 and 1.38 times higher, respectively.

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