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Vascular factors and cognition: toward a prevention of dementia?

Christophe Tzourio1

  • 1INSERM U360 Hôpital de la Salpêtrière, Paris, France. tzourio@chups.jussieu.fr

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension
|September 5, 2003
PubMed

Insights

Blood pressure lowering treatment significantly reduced cognitive decline in patients with prior stroke or TIA. This intervention also lowered dementia and cognitive decline risk associated with recurrent stroke.

Area of Science:

  • Neurology
  • Cardiology
  • Gerontology

Background:

  • High blood pressure is a significant risk factor for stroke and dementia.
  • The preventative effects of blood pressure reduction on dementia remain largely unknown.
  • Cerebrovascular disease increases the risk of cognitive impairment and dementia.

Purpose of the Study:

  • To evaluate the impact of an angiotensin-converting enzyme (ACE) inhibitor-based regimen on stroke risk.
  • To determine if blood pressure lowering treatment can prevent dementia and cognitive decline in patients with a history of stroke or transient ischaemic attack (TIA).

Main Methods:

  • The Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) randomized 6105 patients to active treatment or placebo.
  • Active treatment included perindopril, with indapamide added for eligible patients.
  • Cognitive decline was defined as a ≥3-point drop on the Mini-Mental State Examination (MMSE); dementia was diagnosed using DSM-IV criteria.

Main Results:

  • Active treatment reduced the risk of cognitive decline by 19% (P=0.01) but did not significantly reduce dementia risk (P=0.2).
  • Among patients experiencing a recurrent stroke, dementia risk was reduced by 34% (P=0.03) and cognitive decline by 45% (P<0.001).
  • Blood pressure lowering treatment demonstrated a significant reduction in cognitive decline and dementia risk, particularly when associated with recurrent stroke.

Conclusions:

  • Blood pressure lowering treatment with perindopril and indapamide is effective in reducing cognitive decline in patients with cerebrovascular disease.
  • The findings support the use of this regimen for patients with a history of stroke or TIA to mitigate cognitive decline.
  • This treatment strategy is recommended for all patients with cerebrovascular disease to prevent cognitive impairment and dementia.

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