DEMENTIA & ALZHEIMERS
LINKED TO
HIGH BLOOD PRESSURE
What is Dementia?
Dementia is a syndrome, not a disease, that dementia covers a number of disorders of the brain that have an impact on a person’s daily activities, their cognitive functions, including short term memory, working memory, long term memory, mental processes, learning memory, communication.
There are a number of different types of dementia, four most common are listed below.
- Alzheimer’s disease
- Vascular Dementia
- Lewy body dementia
- Frontotemporal dementia
Although symptoms of these conditions may in some cases have similarities, it is important that doctors, consultants and health professionals are able to distinguish between them, this will ensure each condition gets the correct treatment and ongoing management.
Let’s recap on high blood pressure that’s not controlled.
As explained in other sections, high blood pressure can be a cause of heart disease, stroke and many other serious conditions, leading to a significant risk of Cognitive decline. Hypertension measured in young adults in the age bracket 20-40 years, middle age and senior citizens has highlighted that high blood pressure in young adults may be a cause of cognitive decline, impairment and dementia in later life.
Hence it is so important to get blood pressure checked, no matter what age, lowering blood pressure in the early years may play an important part in stopping cognitive decline and possible dementia developing. It also reduces the chances of a stroke or cardiovascular problems; these two conditions are covered in other sections, (6), (8), (30) & (31).
High blood pressure has been linked to changes in the brains nerve cells and arteries in the cortex, increasing the risk of developing alzheimers and vascular dementia.
High blood pressure has been directly linked to problems with short term memory, people often associate short term memory loss with age, however people with high blood pressure, no matter what age, run the risk of damage to arteries in the brain. High blood pressure may cause a buildup of plaque and tissue, should small particles of plaque break off in larger arteries feeding oxygen rich blood to the brain, any small particle may become trapped when it reaches very small arteries, this can block oxygen rich blood reaching nerve cells in the brain that form part of your memory, should this happen, the brain cells will die.
Damage to arteries
Damage to arteries caused by high blood pressure contributes to dementia conditions. Managing blood pressure is so important, every part of the human body is impacted by high blood pressure, always remember the medical profession refer to high blood pressure as the ‘Silent Killer’
Vascular Dementia & Atherosclerosis
Vascular Dementia, also referred to as multi-infarct dementia and vascular cognitive impairment, is a type of dementia caused by problems in the supply of oxygen rich blood to the brain. This can be caused by a number of minor strokes leading to cognitive decline. Alternatively, there can be reduced blood supply to the brain caused by atherosclerosis which damages the small intracranial (within the brain) blood vessels. A healthy brain needs a constant supply of blood bringing oxygen and nutrients to cells within the brain. Blood flows to the brain through a complex network of arteries, this is called the vascular system.
There is another condition called ‘Silent Stroke’. When a silent stroke occurs, it’s possible the person may be totally unaware, however, although this type of stroke may have no symptoms, the person then becomes vulnerable to having a TIA (Transient Ischemic Attack).
Atherosclerosis is a disease caused by a build-up of plaque on the walls of your arteries, this disease is also responsible for hardening the arteries in your brain and body. It’s your arteries that carry oxygen rich blood to every part of your body including your brain. People with high blood pressure become exposed to developing atherosclerosis due to the increased force of blood pressure which can cause damage to the wall of your arteries, it’s this damage that leads to a build-up of plaque. The source of plaque can come from LDL cholesterol, calcium, smoking and other substances in the blood that contribute to the build-up of plaque. Fat is another alleged source of plaque, however there are conflicting thoughts on unsaturated fats as opposed to saturated fats, insulin resistance also plays a part in an increase of blood pressure due to body fat and obesity. This is a very interesting subject, we will be writing another section putting forward the different thoughts and the implications on keeping a healthy body. One thing for sure, lack of exercise and eating processed food can contribute to atherosclerosis.
Cerebrovascular Disease
Cerebrovascular Disease include several medical conditions that affect blood vessels in the brain. Damage to the cerebral arteries in the brain restrict the flow of oxygen rich blood to cells within the brain. If the blood vessels (The Vascular System) in the brain are damaged, causing blood vessels to leak or become blocked, this will reduce or stop oxygen rich blood reaching brain cells which will eventually die. It’s when brain cells die, the problems with memory, reasoning, thinking and communication become evident. Together these conditions are known as cognition, it’s when these cognitive problems affect a persons’ daily life, it’s described as vascular dementia.
Memory, Reasoning, Thinking and Communication
It’s when brain cells die, the problems with memory, reasoning, thinking and communication become evident. Together these conditions are known as cognition, it’s when these cognitive problems affect a persons’ daily life, this is described as vascular dementia.
Every 3 seconds someone in the world develops dementia. However, the majority of people do not receive a diagnosis – let alone treatment and care. In 2017, there was a prediction there would be 10 million new cases of dementia. These figures to date have not been published. It’s been estimated as few as 10% of people living with dementia will receive a diagnosis.
Alzheimers Disease
Alzheimers Disease is considered the most common type of dementia that develops with senior citizens, normally over 65 years old, although very unusual, some cases of alzheimers have been diagnosed in young people, some as young as 20 years old.
There are genetic conditions that can be passed down from parents, although very rare, just one faulty gene could lead to dementia in later life. The apolipoprotein E (APOE) gene is responsible for producing a protein called apolipoprotein E. When the gene is working correctly, it maintains the correct levels of cholesterol. When the APOE gene is defective, it can increase the risk of atherosclerosis which, as explained above damages arteries providing oxygen to the brain, resulting in the death of brain cells and eventually the syndrome of dementia A defective APOE gene is also linked to a higher risk of heart disease, stroke and hypertension.
Dr. Alois Alzheimer
Alzheimers Disease is named after Dr. Alois Alzheimer in 1906. It was Dr Alzheimer who noticed changes in the brain tissue of a 50-year-old woman who had died from a mental illness. When she was alive her family noticed unpredictable behaviour, loss of memory, especially short-term memory, also affected her speech. Dr Alois Alzheimer at that time was a research assistant to Emil Kraepelin who was a leading German psychiatrist of that era. However, it was Dr Alzheimer who presented the case of the 50-year-old woman who died of an unusual mental illness to a psychiatry meeting in 1906 and followed this up by writing a paper on his findings in 1907. It was in 1910 that Dr Emil Kraepelin referred to the condition presented by Dr Alzheimer as ‘Alzheimers Disease’. Since that time the condition Alzheimers disease is still being referred to as a common cause of dementia. Dr Alois Alzheimer died in 1915 at the age of 51.
Dr Emil Kraepelin
Dr Emil Kraepelin was an eminent German Psychiatrist born in the 19th Century. He dedicated many years to writing his psychiatric book. Below is an extract from Dr Kraepelin’s ‘Handbook of Psychiatry‘. Dr Emil Kraepelin died in 1926 at the age of 70.
"The autopsy reveals, according to Alzheimer's description, changes that represent the most serious form of senile dementia, the Drusen were numerous and almost one-third of the cortical cells had died off. In their place instead, we found peculiar deeply stained fibrillary bundles that were closely packed to one another and seemed to be remnants of degenerated cell bodies. The clinical interpretation of this Alzheimer's disease is still confused. While the anatomical findings suggest that we are dealing with a particularly serious form of senile dementia, the fact that this disease sometimes starts already around the age of 40 does not allow this supposition [i.e. it should be considered as a new disease]. In such cases we should at least assume a 'senium praecox' if not perhaps a more or less age-independent unique disease process."
What is Alzheimers disease?
Alzheimers is a progressive disease, causing symptoms of dementia to get worse over years. Medical research has found that symptoms in the early stages are mild, however, as the disease progresses, people have problems remembering recent events and retaining new information. These two conditions indicate early damage to the hippocampus which is divided into halves, one each side of the brain. The hippocampus function is mainly connected with memory, especially long-term memories, some of which are retained, it’s the memory of recent events that is affected. Other functions of the hippocampus include the memory responsible for the location of objects or people, in addition, when the hippocampus fails to work correctly it’s possible we won’t be able to remember where we live.
Stages of Alzheimers
Stages of Alzheimers can vary person to person, although there are several stages of alzheimers disease, basically, early stage, middle stage and late stage, part of the early stage is detailed above. The middle stage is said to be spread over many years, as the disease progresses the person will require more care as time passes. Frustration and irritability are symptoms where the person can’t express themselves and refuse to carry out day to day personal care, even refusing to shower or have a bath, although symptoms can vary from person to person, some of the possible symptoms are listed below.
- Forgetting appointments
- Forgetting where items are placed
- Difficulty finding the right words when in conversation
- Difficulty in spelling
- Mood changes
- Unacceptable behaviour
- Making poor decisions
- Lacking in motivation
- Unable to recognise faces
- Changes in sense of humour
- Difficulty in solving problems
- Losing track of time
- Losing track of dates
- Poor judgement
There are many similar symptoms that are age related and not early signs of alzheimers disease. There is a condition called’ Age associated memory impairment’ this is when there is no underlying medical condition, it’s when the memory starts to decline just due to aging. If you wish to know more, click on this link:
The middle stage
The middle stage as mentioned may be spread over a number of years. When this stage is reached the person may become frustrated expressing difficulty in carrying out daily routine jobs. Listed below are some of the symptoms that may occur during this stage of the disease.
- Being unsure, what day it is
- Unable to dress themselves appropriately
- Sleeping during the day
- Unable to sleep, become restless
- Could wander off and forget where they came from
- Forgetting past events
- Forgetting names of friends and family
- Becoming moody
- Possibly unable to control bladder and bowels
- Including conditions listed above
When a person reaches the later stages of alzheimers disease, the symptoms become very distressing and restricts the person suffering from alzheimers from living any sort of a normal life. Additional symptoms include:
- Restriction in the ability to walk or sit comfortably
- Difficulties in communicating with family or carer
- Unaware of familiar surroundings
- Can appear to be living in a world of their own
- Needing round the clock care
- Difficulties in swallowing
Let’s recap on blood pressure
Let’s recap on blood pressure, research over many past years has identified that high blood pressure will increase the risk of developing dementia and associated diseases such as vascular dementia and alzheimers in later life.
High blood pressure can be a cause of some of the conditions listed below.
- Atherosclerosis which is a build-up of plaque in arteries which restricts the flow of oxygen rich blood.
- Blockages in arteries within the brain. When the blockage is temporary (less than 24 hours) it can cause a TIA (transient ischaemic attack) or when the blockage is persistent or permanent it can cause a stroke. More information on these conditions in section (8).
Researchers have studies the side effects of some drugs that can cause dementia.
These drugs block chemical messengers and neurotransmitters within the brain. Neurons use acetylcholine (a neurotransmitter) to send messages within and outside the brain controlling muscle, movement, cognitive function and behaviour. Below are brand and generic names of anticholinergic drugs.
These drugs are successful medications prescribed for many conditions, however, as with all drugs, the pharmaceutical companies manufacturing any drug provide a list of possible side effects, it doesn’t mean people will suffer from side effects, it’s just a possibility.
When these neurotransmitters (chemical messengers) are blocked the body and brain becomes dysfunctional. Here are some anticholinergic drugs (drugs that can predispose to dementia):
| BRAND NAME | GENERIC NAME | |
|---|---|---|
| Artane | Trihexyphenidyl | |
| Atrovent | Ipratropium | |
| Cogentin | Benztropine | |
| Detrol | Mesylate | |
| Ditropan | Oxybutynin | |
| Enablex | Darifenacin | |
| Levsinex | Hyoscyamine | |
| Norflex | Orphenadrine | |
| Pro-Banthine | Propantheline | |
| Spiriva | Tiotropium | |
| Toviaz | Fesoterodine | |
| Urispas | Flavoxate | |
| Vesicare | Solifenacin |
Is there a drug to cure Dementia?
Currently there are no drugs to cure Dementia, however, there are medications (Drugs) than can help relieve some of the symptoms. To explain more, within the brain of a person suffering with alzheimers, there are low levels of a chemical called acetylcholine, a hormone (chemical). This chemical (acetylcholine) is very important for sending messages between nerve cells, which are responsible for memory and body functions. When the level of acetylcholine is low, memory and body functions are affected.
When these neurotransmitters (chemical messengers) are blocked by anticholinergic medication (Drugs) the body and brain become dysfunctional. Anticholinergic drugs can predispose to dementia.
No drugs to cure Alzheimers
Although there are no drugs to cure alzheimers, there are drugs that may assist the memory and body functions by increasing the level of acetylcholine in the brain.
| BRAND NAME | GENERIC NAME | |
|---|---|---|
| Donepezil | Aricept | |
| Galantamine | Razadyne Reminyl | |
| Rivastigmine | Exelon (This is a patch) | |
| Tacrine | Cognex |
Like all medications, the list of drugs above all have side effects, changes in blood pressure is one of the side effects. Donepezil and Galantamine may cause low blood pressure, Rivastigmine may raise blood pressure. Tacrine may raise or lower blood pressure. Always remember, research links high blood pressure with all types of dementia and cognitive decline. Read more about causes of high blood pressure in other sections of this website.
Looking Forward
Looking Forward, more needs to be done to tackle the stigma surrounding dementia. Individuals who are diagnosed often receive a lower standard of care and may face exclusion from everyday life. Without a diagnosis, people with dementia and their care partners are unable to access the treatment and support they need.
The world’s leading experts are calling on all people to recognise the warning signs of dementia so that they may seek advice and support as early as possible. A diagnosis of dementia made earlier during the disease is fundamental to ensure that those affected can live as well as possible. Earlier diagnosis is important because:
It enables people with dementia and their care partners to be better equipped to cope with progression of the disease, including the ability to make decisions about their independence, home, and legal affairs while they still have the capacity to do so. It gives people with dementia a better chance to benefit from available drug and non-drug therapies that may improve their cognition and enhance their quality of life.
When diagnosed early enough, it allows those affected to make a significant difference to research, by taking part in new clinical trials. There is no simple test to make a diagnosis of dementia. A reasonably accurate diagnosis can be made by taking a careful history of the person’s problem from the individual alongside a close relative or friend, together with an examination of the individual’s physical and mental state.
More research into diagnosis of dementia is paramount but has historically focused on patients already exhibiting dementia symptoms. Clinical trials performed in these people were disappointing. Recent diagnostic efforts have begun to recognize the importance of a long pre-dementia stage in the disease and favour the development of therapies and other interventions early in the disease progression. This suggests that as the understanding of the disease grows, early diagnosis will become ever more important. This must be accompanied by increasing healthcare capacity, and better care.
A global plan on dementia
A global plan on dementia was adopted by the World Health Organization (WHO) in May 2017 urging every government to develop awareness and access to diagnosis for dementia. The plan included a target for 145 governments to have a national plan by 2025, however, to date, less than 30 of the 194 WHO member states have developed a plan on dementia. Alzheimer associations in over 90 countries are engaged in advocacy to encourage the development of these plans, providing support and advice for seeking a diagnosis, and life after a diagnosis is made.
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