Having hypertension in midlife (ages 40 through 60) is associated with elevated risk of cognitive impairment and Alzheimer’s dementia later in life—even more so than having the so-called Alzheimer’s gene.
Higher Blood Pressure May Lead to Brain Shrinkage
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
“It is clear that [hardening of the arteries inside our brain] and cognitive decline travel hand in hand,” something I’ve addressed before. “However, the independent association of [Alzheimer’s] with multiple [atherosclerotic vascular disease] risk factors suggests that cholesterol is not the sole culprit in dementia.”
One of the “most consistent finding[s]” is “elevated…levels of blood pressure” in “mid-life”, (meaning ages 40 through 60) is associated with elevated risk of cognitive impairment and Alzheimer’s dementia later in life. In fact, even more so than having the so-called Alzheimer’s gene.
“The normal arterial tree”—all the blood vessels in the brain—”…is designed as both a conduit and cushion.” But, when the artery walls become stiffened, every time our heart pumps blood up into our brain, the pressure from the pulse can damage small vessels in our brains. This can cause what are called “microbleeds” in our brain, which are frequently found in people with high blood pressure—even if they were never diagnosed with a stroke.
These microbleeds may be “one of the important factors that cause cognitive impairments”—perhaps not surprisingly, because on autopsy, “microbleeds may be associated with [brain] tissue necrosis,” meaning brain tissue death.
And, speaking of tissue death, high blood pressure is also associated with so-called “lacunar infarcts”—from the Latin word lacuna, meaning hole. Holes in our brain that appear when little arteries get clogged in our brain, and result in the death of a little round region of the brain. Up to a quarter of the elderly have these little ministrokes, and most don’t even know it—so-called silent infarcts, but “no black holes in the brain are benign.” This is what they look like—it’s like your brain has been hole-punched.
Although silent infarcts, by definition, lack…overt stroke-like symptoms, they are associated with subtle deficits in physical and cognitive function that commonly go unnoticed.” And, they can “[double] the risk of…dementia.” That’s one of the ways high blood pressure is linked to dementia.
So much damage that “high [blood pressure] levels [can] lead to brain volume reduction,” literally a shrinkage of our brain—”specifically in [the] hippocampus,” the memory center of the brain. This helps explain how high blood pressure can be involved in the development of Alzheimer’s disease.
One can actually visualize the little arteries in the back of our eyes, using an ophthalmoscope, providing “a noninvasive window to study” the health of one’s intracranial arteries, the little vessels inside our head. The researchers found “a significant association” between arterial disease and brain shrinkage on MRI.
But, this was a cross-sectional study, just a snapshot in time; so, you can’t prove cause and effect. What you need is a prospective study, following people over time; and so, that’s what they did. Over a ten-year period, those with signs of arterial disease were twice as likely to suffer a significant loss of brain tissue volume over time.
Please consider volunteering to help out on the site.
- Launer LJ. The epidemiologic study of dementia: a life-long quest? Neurobiol Aging. 2005 Mar;26(3):335-40.
- Alzheimer A, Stelzmann RA, Schnitzlein HN, Murtagh FR. An English translation of Alzheimer's 1907 paper, "Uber eine eigenartige Erkankung der Hirnrinde". Clin Anat. 1995;8(6):429-31.
- Ramirez-Bermudez J. Alzheimer's disease: critical notes on the history of a medical concept. Arch Med Res. 2012 Nov;43(8):595-9.
- de la Torre JC. Vascular basis of Alzheimer's pathogenesis. Ann N Y Acad Sci. 2002 Nov;977:196-215.
- de la Torre JC. Impaired brain microcirculation may trigger Alzheimer's disease. Neurosci Biobehav Rev. 1994 Fall;18(3):397-401.
- de la Torre JC. The vascular hypothesis of Alzheimer's disease: bench to bedside and beyond. Neurodegener Dis. 2010;7(1-3):116-21.
- de la Torre JC. Vascular risk factors: a ticking time bomb to Alzheimer's disease. Am J Alzheimers Dis Other Demen. 2013 Sep;28(6):551-9.
- Korczyn AD. Mixed dementia--the most common cause of dementia. Ann N Y Acad Sci. 2002 Nov;977:129-34.
- Costanza A, Xekardaki A, Kövari E, Gold G, Bouras C, Giannakopoulos P. Microvascular burden and Alzheimer-type lesions across the age spectrum. J Alzheimers Dis. 2012;32(3):643-52.
- Marshall RS, Lazar RM, Pile-Spellman J, Young WL, Duong DH, Joshi S, Ostapkovich N. Recovery of brain function during induced cerebral hypoperfusion. Brain. 2001 Jun;124(Pt 6):1208-17.
- Román GC. Vascular dementia may be the most common form of dementia in the elderly. J Neurol Sci. 2002 Nov 15;203-204:7-10.
- [No authors listed] Cardiogenic Dementia. Lancet. 1977 Jan 1;1(8001):27-8.
- Kalaria RN, Akinyemi R, Ihara M. Does vascular pathology contribute to Alzheimer changes? J Neurol Sci. 2012 Nov 15;322(1-2):141-7.
- Henskens LH, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Lodder J. Brain microbleeds are associated with ambulatory blood pressure levels in a hypertensive population. Hypertension. 2008 Jan;51(1):62-8.
- Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003 Mar 27;348(13):1215-22.
- Pullicino P. Review: silent brain infarcts are common in the elderly general population. Evid Based Med. 2008 Jun;13(3):88.
- Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007 Jul;6(7):611-9.
- Saini M, Ikram K, Hilal S, Qiu A, Venketasubramanian N, Chen C. Silent stroke: not listened to rather than silent. Stroke. 2012 Nov;43(11):3102-4.
- Schneider JA. Brain microbleeds and cognitive function. Stroke. 2007 Jun;38(6):1730-1.
- Seo SW, Hwa Lee B, Kim EJ, Chin J, Sun Cho Y, Yoon U, Na DL. Clinical significance of microbleeds in subcortical vascular dementia. Stroke. 2007 Jun;38(6):1949-51.
- Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, Petersen RC, Schneider JA, Tzourio C, Arnett DK, Bennett DA, Chui HC, Higashida RT, Lindquist R, Nilsson PM, Roman GC, Sellke FW, Seshadri S; American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011 Sep;42(9):2672-713.
- Gress DR. The problem with asymptomatic cerebral embolic complications in vascular procedures: what if they are not asymptomatic? J Am Coll Cardiol. 2012 Oct 23;60(17):1614-6.
- Rincon F, Wright CB. Vascular cognitive impairment. Curr Opin Neurol. 2013 Feb;26(1):29-36.
- Roher AE, Tyas SL, Maarouf CL, Daugs ID, Kokjohn TA, Emmerling MR, Garami Z, Belohlavek M, Sabbagh MN, Sue LI, Beach TG. Intracranial atherosclerosis as a contributing factor to Alzheimer's disease dementia. Alzheimers Dement. 2011 Jul;7(4):436-44.
- Beauchet O, Celle S, Roche F, Bartha R, Montero-Odasso M, Allali G, Annweiler C. Blood pressure levels and brain volume reduction: a systematic review and meta-analysis. J Hypertens. 2013 Aug;31(8):1502-16.
- Zhu J, Wang Y, Li J, Deng J, Zhou H. Intracranial artery stenosis and progression from mild cognitive impairment to Alzheimer disease. Neurology. 2014 Mar 11;82(10):842-9.
- Viswanathan A, Rocca WA, Tzourio C. Vascular risk factors and dementia: how to move forward? Neurology. 2009 Jan 27;72(4):368-74.
- Kovacic JC, Fuster V. Atherosclerotic risk factors, vascular cognitive impairment, and Alzheimer disease. Mt Sinai J Med. 2012 Nov-Dec;79(6):664-73.
- Dolan H, Crain B, Troncoso J, Resnick SM, Zonderman AB, Obrien RJ. Atherosclerosis, dementia, and Alzheimer disease in the Baltimore Longitudinal Study of Aging cohort. Ann Neurol. 2010 Aug;68(2):231-40.
- Altman R, Rutledge JC. The vascular contribution to Alzheimer's disease. Clin Sci (Lond). 2010 Aug 5;119(10):407-21.
- Honig LS, Kukull W, Mayeux R. Atherosclerosis and AD: analysis of data from the US National Alzheimer's Coordinating Center. Neurology. 2005 Feb 8;64(3):494-500.
- Deschaintre Y, Richard F, Leys D, Pasquier F. Treatment of vascular risk factors is associated with slower decline in Alzheimer disease. Neurology. 2009 Sep 1;73(9):674-80.
- Kelleher RJ, Soiza RL. Evidence of endothelial dysfunction in the development of Alzheimer's disease: Is Alzheimer's a vascular disorder? Am J Cardiovasc Dis. 2013 Nov 1;3(4):197-226.
- Pase MP, Herbert A, Grima NA, Pipingas A, O'Rourke MF. Arterial stiffness as a cause of cognitive decline and dementia: a systematic review and meta-analysis. Intern Med J. 2012 Jul;42(7):808-15.
- Yarchoan M, Xie SX, Kling MA, Toledo JB, Wolk DA, Lee EB, Van Deerlin V, Lee VM, Trojanowski JQ, Arnold SE. Cerebrovascular atherosclerosis correlates with Alzheimer pathology in neurodegenerative dementias. Brain. 2012 Dec;135(Pt 12):3749-56.
- Kawasaki R, Cheung N, Mosley T, Islam AF, Sharrett AR, Klein R, Coker LH, Knopman DS, Shibata DK, Catellier D, Wong TY. Retinal microvascular signs and 10-year risk of cerebral atrophy: the Atherosclerosis Risk in Communities (ARIC) study. Stroke. 2010 Aug;41(8):1826-8.
- Wong TY, Mosley TH Jr, Klein R, Klein BE, Sharrett AR, Couper DJ, Hubbard LD; Atherosclerosis Risk in Communities Study. Retinal microvascular changes and MRI signs of cerebral atrophy in healthy, middle-aged people. Neurology. 2003 Sep 23;61(6):806-11.
- Norrving B. Lacunar infarcts: no black holes in the brain are benign. Pract Neurol. 2008 Aug;8(4):222-8.
Image credit: KlausHausmann via pixabay. Image has been modified.
Video credit: Tyler McReynolds, Teetotalin LLC.
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
“It is clear that [hardening of the arteries inside our brain] and cognitive decline travel hand in hand,” something I’ve addressed before. “However, the independent association of [Alzheimer’s] with multiple [atherosclerotic vascular disease] risk factors suggests that cholesterol is not the sole culprit in dementia.”
One of the “most consistent finding[s]” is “elevated…levels of blood pressure” in “mid-life”, (meaning ages 40 through 60) is associated with elevated risk of cognitive impairment and Alzheimer’s dementia later in life. In fact, even more so than having the so-called Alzheimer’s gene.
“The normal arterial tree”—all the blood vessels in the brain—”…is designed as both a conduit and cushion.” But, when the artery walls become stiffened, every time our heart pumps blood up into our brain, the pressure from the pulse can damage small vessels in our brains. This can cause what are called “microbleeds” in our brain, which are frequently found in people with high blood pressure—even if they were never diagnosed with a stroke.
These microbleeds may be “one of the important factors that cause cognitive impairments”—perhaps not surprisingly, because on autopsy, “microbleeds may be associated with [brain] tissue necrosis,” meaning brain tissue death.
And, speaking of tissue death, high blood pressure is also associated with so-called “lacunar infarcts”—from the Latin word lacuna, meaning hole. Holes in our brain that appear when little arteries get clogged in our brain, and result in the death of a little round region of the brain. Up to a quarter of the elderly have these little ministrokes, and most don’t even know it—so-called silent infarcts, but “no black holes in the brain are benign.” This is what they look like—it’s like your brain has been hole-punched.
Although silent infarcts, by definition, lack…overt stroke-like symptoms, they are associated with subtle deficits in physical and cognitive function that commonly go unnoticed.” And, they can “[double] the risk of…dementia.” That’s one of the ways high blood pressure is linked to dementia.
So much damage that “high [blood pressure] levels [can] lead to brain volume reduction,” literally a shrinkage of our brain—”specifically in [the] hippocampus,” the memory center of the brain. This helps explain how high blood pressure can be involved in the development of Alzheimer’s disease.
One can actually visualize the little arteries in the back of our eyes, using an ophthalmoscope, providing “a noninvasive window to study” the health of one’s intracranial arteries, the little vessels inside our head. The researchers found “a significant association” between arterial disease and brain shrinkage on MRI.
But, this was a cross-sectional study, just a snapshot in time; so, you can’t prove cause and effect. What you need is a prospective study, following people over time; and so, that’s what they did. Over a ten-year period, those with signs of arterial disease were twice as likely to suffer a significant loss of brain tissue volume over time.
Please consider volunteering to help out on the site.
- Launer LJ. The epidemiologic study of dementia: a life-long quest? Neurobiol Aging. 2005 Mar;26(3):335-40.
- Alzheimer A, Stelzmann RA, Schnitzlein HN, Murtagh FR. An English translation of Alzheimer's 1907 paper, "Uber eine eigenartige Erkankung der Hirnrinde". Clin Anat. 1995;8(6):429-31.
- Ramirez-Bermudez J. Alzheimer's disease: critical notes on the history of a medical concept. Arch Med Res. 2012 Nov;43(8):595-9.
- de la Torre JC. Vascular basis of Alzheimer's pathogenesis. Ann N Y Acad Sci. 2002 Nov;977:196-215.
- de la Torre JC. Impaired brain microcirculation may trigger Alzheimer's disease. Neurosci Biobehav Rev. 1994 Fall;18(3):397-401.
- de la Torre JC. The vascular hypothesis of Alzheimer's disease: bench to bedside and beyond. Neurodegener Dis. 2010;7(1-3):116-21.
- de la Torre JC. Vascular risk factors: a ticking time bomb to Alzheimer's disease. Am J Alzheimers Dis Other Demen. 2013 Sep;28(6):551-9.
- Korczyn AD. Mixed dementia--the most common cause of dementia. Ann N Y Acad Sci. 2002 Nov;977:129-34.
- Costanza A, Xekardaki A, Kövari E, Gold G, Bouras C, Giannakopoulos P. Microvascular burden and Alzheimer-type lesions across the age spectrum. J Alzheimers Dis. 2012;32(3):643-52.
- Marshall RS, Lazar RM, Pile-Spellman J, Young WL, Duong DH, Joshi S, Ostapkovich N. Recovery of brain function during induced cerebral hypoperfusion. Brain. 2001 Jun;124(Pt 6):1208-17.
- Román GC. Vascular dementia may be the most common form of dementia in the elderly. J Neurol Sci. 2002 Nov 15;203-204:7-10.
- [No authors listed] Cardiogenic Dementia. Lancet. 1977 Jan 1;1(8001):27-8.
- Kalaria RN, Akinyemi R, Ihara M. Does vascular pathology contribute to Alzheimer changes? J Neurol Sci. 2012 Nov 15;322(1-2):141-7.
- Henskens LH, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Lodder J. Brain microbleeds are associated with ambulatory blood pressure levels in a hypertensive population. Hypertension. 2008 Jan;51(1):62-8.
- Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003 Mar 27;348(13):1215-22.
- Pullicino P. Review: silent brain infarcts are common in the elderly general population. Evid Based Med. 2008 Jun;13(3):88.
- Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007 Jul;6(7):611-9.
- Saini M, Ikram K, Hilal S, Qiu A, Venketasubramanian N, Chen C. Silent stroke: not listened to rather than silent. Stroke. 2012 Nov;43(11):3102-4.
- Schneider JA. Brain microbleeds and cognitive function. Stroke. 2007 Jun;38(6):1730-1.
- Seo SW, Hwa Lee B, Kim EJ, Chin J, Sun Cho Y, Yoon U, Na DL. Clinical significance of microbleeds in subcortical vascular dementia. Stroke. 2007 Jun;38(6):1949-51.
- Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, Petersen RC, Schneider JA, Tzourio C, Arnett DK, Bennett DA, Chui HC, Higashida RT, Lindquist R, Nilsson PM, Roman GC, Sellke FW, Seshadri S; American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011 Sep;42(9):2672-713.
- Gress DR. The problem with asymptomatic cerebral embolic complications in vascular procedures: what if they are not asymptomatic? J Am Coll Cardiol. 2012 Oct 23;60(17):1614-6.
- Rincon F, Wright CB. Vascular cognitive impairment. Curr Opin Neurol. 2013 Feb;26(1):29-36.
- Roher AE, Tyas SL, Maarouf CL, Daugs ID, Kokjohn TA, Emmerling MR, Garami Z, Belohlavek M, Sabbagh MN, Sue LI, Beach TG. Intracranial atherosclerosis as a contributing factor to Alzheimer's disease dementia. Alzheimers Dement. 2011 Jul;7(4):436-44.
- Beauchet O, Celle S, Roche F, Bartha R, Montero-Odasso M, Allali G, Annweiler C. Blood pressure levels and brain volume reduction: a systematic review and meta-analysis. J Hypertens. 2013 Aug;31(8):1502-16.
- Zhu J, Wang Y, Li J, Deng J, Zhou H. Intracranial artery stenosis and progression from mild cognitive impairment to Alzheimer disease. Neurology. 2014 Mar 11;82(10):842-9.
- Viswanathan A, Rocca WA, Tzourio C. Vascular risk factors and dementia: how to move forward? Neurology. 2009 Jan 27;72(4):368-74.
- Kovacic JC, Fuster V. Atherosclerotic risk factors, vascular cognitive impairment, and Alzheimer disease. Mt Sinai J Med. 2012 Nov-Dec;79(6):664-73.
- Dolan H, Crain B, Troncoso J, Resnick SM, Zonderman AB, Obrien RJ. Atherosclerosis, dementia, and Alzheimer disease in the Baltimore Longitudinal Study of Aging cohort. Ann Neurol. 2010 Aug;68(2):231-40.
- Altman R, Rutledge JC. The vascular contribution to Alzheimer's disease. Clin Sci (Lond). 2010 Aug 5;119(10):407-21.
- Honig LS, Kukull W, Mayeux R. Atherosclerosis and AD: analysis of data from the US National Alzheimer's Coordinating Center. Neurology. 2005 Feb 8;64(3):494-500.
- Deschaintre Y, Richard F, Leys D, Pasquier F. Treatment of vascular risk factors is associated with slower decline in Alzheimer disease. Neurology. 2009 Sep 1;73(9):674-80.
- Kelleher RJ, Soiza RL. Evidence of endothelial dysfunction in the development of Alzheimer's disease: Is Alzheimer's a vascular disorder? Am J Cardiovasc Dis. 2013 Nov 1;3(4):197-226.
- Pase MP, Herbert A, Grima NA, Pipingas A, O'Rourke MF. Arterial stiffness as a cause of cognitive decline and dementia: a systematic review and meta-analysis. Intern Med J. 2012 Jul;42(7):808-15.
- Yarchoan M, Xie SX, Kling MA, Toledo JB, Wolk DA, Lee EB, Van Deerlin V, Lee VM, Trojanowski JQ, Arnold SE. Cerebrovascular atherosclerosis correlates with Alzheimer pathology in neurodegenerative dementias. Brain. 2012 Dec;135(Pt 12):3749-56.
- Kawasaki R, Cheung N, Mosley T, Islam AF, Sharrett AR, Klein R, Coker LH, Knopman DS, Shibata DK, Catellier D, Wong TY. Retinal microvascular signs and 10-year risk of cerebral atrophy: the Atherosclerosis Risk in Communities (ARIC) study. Stroke. 2010 Aug;41(8):1826-8.
- Wong TY, Mosley TH Jr, Klein R, Klein BE, Sharrett AR, Couper DJ, Hubbard LD; Atherosclerosis Risk in Communities Study. Retinal microvascular changes and MRI signs of cerebral atrophy in healthy, middle-aged people. Neurology. 2003 Sep 23;61(6):806-11.
- Norrving B. Lacunar infarcts: no black holes in the brain are benign. Pract Neurol. 2008 Aug;8(4):222-8.
Image credit: KlausHausmann via pixabay. Image has been modified.
Video credit: Tyler McReynolds, Teetotalin LLC.
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Higher Blood Pressure May Lead to Brain Shrinkage
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Content URLDoctor's Note
What can we do about high blood pressure? A lot! See, for example:
- Hibiscus Tea vs. Plant-Based Diets for Hypertension
- Flaxseeds for Hypertension
- How to Prevent High Blood Pressure with Diet
- How to Treat High Blood Pressure with Diet
- High Blood Pressure May Be a Choice
- Sprinkling Doubt: Taking Sodium Skeptics with a Pinch of Salt
- Kempner Rice Diet: Whipping Us Into Shape
- The Evidence That Salt Raises Blood Pressure
- Oxygenating Blood with Nitrate-Rich Vegetables
- How Not to Die from High Blood Pressure
What else can we do to forestall cognitive decline or dementia? I referenced my video Alzheimer’s and Atherosclerosis of the Brain earlier, and here are other videos that offer information on treatment and prevention:
- Cholesterol and Alzheimer’s Disease
- Alzheimer’s Disease: Grain Brain or Meathead?
- Treating Alzheimer’s with Turmeric
- Preventing Alzheimer’s Disease with Plants
- Reducing Glycotoxin Intake to Prevent Alzheimer’s
- Alzheimer’s May Start Decades Before Diagnosis
- The Alzheimer’s Gene: Controlling ApoE
- Preventing Brain Loss with B Vitamins?
- How to Slow Brain Aging by Two Years
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