Vaskuläre Demenz und Hypertonie

Zusammenfassung

Dementielle Erkrankungen sind in den kommenden Jahren eine wachsende Herausforderung für unser Gesundheitssystem. Da es bislang keine therapeutischen Möglichkeiten gibt, um eine manifeste Demenz effektiv zu behandeln, sind Maßnahmen zur Primärprävention von herausragender Bedeutung. Zu den gesicherten Risikofaktoren für vaskuläre Demenzen gehört die arterielle Hypertonie. Auch bei Patienten mit Alzheimerdemenz führt eine Hypertonie vermutlich dazu, dass sich die kognitive Situation schnell verschlechtert. Eine konsequente Blutdruckeinstellung, spätestens im mittleren Lebensalter, ist eine entscheidende Möglichkeit zur Prävention kognitiver Funktionsverluste. Darüberhinaus ist es wichtig, auch die anderen bekannten kardiovaskulären Risikofaktoren einzustellen. Regelmäßige körperliche Aktivität und Pflege sozialer Kontakte sind die Basis der Präventionsmöglichkeiten. Eine rechtzeitige medikamentöse antihypertensive Therapie kann das Fortschreiten von kognitiven Funktionseinbußen zumindest verlangsamen und so den Eintritt einer Demenz z. T. verhindern.

Abstract

Dementia and associated diseases will have increasing impact on economical and social system in most countries. As long as no causal therapy for dementia exists, primary prevention, diagnosis and control of risk factors for dementia are crucial. Uncontrolled hypertension is one of the most important risk factors for vascular dementia. An early antihypertensive treatment may reduce cognitive impairment or at least prolong the time to onset of dementia.

Schlüsselwörter

Hypertonie - Blutdruck - Demenz - Kognitive Funktion - vaskuläre Demenz

Keywords

hypertonia - blood pressure - dementia - cognitive function - vascular dementia

• Literatur

• 1 Deutsches Institut für Medizinische Information und Dokumentation (DIMDI). Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. 10.. Revision German Modification Version 2015. https://www.dimdi.de/static/de/klassi/icd-10-gm/kodesuche/onlinefassungen/htmlgm2015/ (letzter Zugriff: 7. 9. 2015)
• 2 Gauthier S, Reisberg B, Zaudig M et al. Mild cognitive impairment. Lancet 2006; 367: 1262-1270
• 3 Hachinski V, Iadecola C, Petersen RC et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006; 37: 2220-2241
• 4 Van Straaten ECW, Scheltens P, Knol DL et al. Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study. Stroke 2003; 34: 1907-1912
• 5 Schneider JA, Arvanitakis Z, Bang W et al. Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology 2007; 69: 2197-2204
• 6 Gutzmann H, Qazi A. Depression associated with dementia. Z Gerontol Geriat 2015; 48: 305-311
• 7 Kalbe E, Calabrese P, Kohn N et al. Screening for cognitive deficits in Parkinson’s disease with the Parkinson neuropsychometric dementia assessment (PANDA) instrument. Parkinsonism Relat Disord 2008; 14: 93-101
• 8 Frisoni GB, Bocchetta M, Chételat G et al. Imaging markers for Alzheimer disease: Which vs how. Neurology 2013; 81 (05) 487-500
• 9 Savva GM, Wharton SB, Ince PG et al. Age, neuropathology, and dementia. N Engl J Med 2009; 360: 2302-2309
• 10 DGN. Leitlinien für Diagnostik und Therapie in der Neurologie: Diagnose und Therapie von Demenzen. 2009; http://www.dgn.org/images/red_leitlinien/LL_2012/pdf/ll_15_2012_diagnose_und_therapie_von_demenzen.pdf (letzter Zugriff: 7. 9. 2015)
• 11 Kessler J, Calabrese P, Kalbe E et al. DemTect: A new screening method to support diagnosis of dementia. Psycho 2000; 26: 343-347
• 12 Takata Y, Ansai T, Soh I et al. Cognitive function and 10 year mortality in an 85 year-old community-dwelling population. Clin Interv Aging 2014; 9: 1691-1699
• 13 Wiederkehr S, Simard M, Fortin C et al. Validity of the clinical critera for vascular dementia: A critical review. Part II. J Neuropsychiatry Clin Neurosci 2008; 20: 162-177
• 14 DGN. Leitlinien für Diagnostik und Therapie in der Neurologie: Diagnostik und Therapie von Gedächtnisstörungen Entwicklungsstufe. 2012. http://www.awmf.org/uploads/tx_szleitlinien/030-124l_S2e_Ged%C3%A4chtnisst%C3%B6rungen_Diagnostik_Therapie_2012-verl%C3%A4ngert.pdf (letzter Zugriff: 7. 9. 2015)
• 15 Lüders S, Schrader J, Zidek W et al. Ambulatory blood pressure measurement in prehypertension: Analysis of the PHARAO-Study: Prevention of Hypertension with the ACE-inhibitor Ramipril in patients with high-normal blood pressure – a prospective, randomised, controlled prevention trial of the German Hypertension League. J Hypertension 2008; 26: 1487-1496
• 16 Lüders S, Dechend R, Eckert S et al. 24-h-Langzeitblutdruckmessung (ABDM). Der Kardiologe 2013; 7: 194-208
• 17 Mossello E, Pieraccioli M, Nesti N et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med 2015; 175: 578-585
• 18 Rönnemaa E, Zethelius B, Lannfelt L et al. Vascular risk factors and dementia: 40-year follow-up of a population-based cohort. Dement Geriatr Cogn Disord 2011; 31: 460-466
• 19 Lüders S, Saathoff U, Haller H et al. Häufigkeit kognitiver Funktionsstörungen bei Patienten mit Begleiterkrankungen – Ergebnisse des DemTect-Registers der Schlaganfall-Kommission der Deutschen Hypertonie-Gesellschaft. Berlin: DHL-Kongress; 2012
• 20 Zieschang T, Hauer K, Schwenk M. Körperliches Training bei Menschen mit Demenz. Dtsch Med Wochenschr 2012; 1370: 1552-1555
• 21 Hess NCL, Dieberg G, McFarlane JR et al. The effect of exercise intervention on cognitive performance in persons at risk of, or with, dementia: A systematic review and meta-analysis. Healthy Aging Research 2014; 3: 3
• 22 Brayne C, Ince PG, Keage HA et al. Education, the brain and dementia: neuroprotection or compensation. Brain 2010; 133: 2210-2216
• 23 Leys D, Henon H, Mackowiak-Cordoliani MA et al. Poststroke dementia. Lancet Neurol 2005; 4: 752-759
• 24 Mellon L, Brewer L, Hall P et al. Cognitive impairment six months after ischaemic stroke: a profile from the ASPIRE-S study. BMC Neurol 2015; 15: 31
• 25 Dufouil C, Godin O, Chalmers J et al. Cerebral white matter hyperintensities predict severe cognitive decline in patients with cerebrovascular disease history. Stroke 2009; 40: 2219-2221
• 26 Sierra C, De la Sierra A, Mercader J et al. Silent cerebral white matter lesions in middle-aged essential hypertensive patients. J Hypertens 2002; 20: 519-524
• 27 Watanabe N, Imai Y, Nagai K et al. Nocturnal blood pressure and silent cerebrovascular lesions in elderly Japanese. Stroke 1996; 27: 1319-1327
• 28 Launer LJ, Ross GW, Petrovitch H et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000; 21: 49-55
• 29 Freitag MH, Peila R, Masaki K et al. Midlife pulse pressure and incidence of dementia: the Honolulu-Asia Aging Study. Stroke 2006; 37: 33-37
• 30 Kivipelto M, Helkala EL, Laakso MP et al. Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease. Ann Intern Med 2002; 137: 149-155
• 31 Launer LJ, Masaki K, Petrovitch H et al. The association between midlife blood pressure levels and late-life cognitive function. JAMA 1995; 274: 1846-1851
• 32 Morris MC, Scherr PA, Hebert LE et al. Association of incident Alzheimer’s disease and blood pressure measured from 13 years before to 2 years after diagnosis in a large community study. Arch Neurol 2001; 58: 1640-1646
• 33 Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol 2005; 4: 487-499
• 34 Knecht S, Wersching H, Lohmann H et al. High-normal blood pressure is associated with poor cognitive performance. Hypertension 2008; 51: 663-668
• 35 Vermeer SE, Prins ND, Heijer den T et al. Silent brain infarcts and the risk of fementia and cognitive decline. N Engl J Med 2003; 348: 1215-1222
• 36 Bernick C, Kuller L, Dulberg C et al. Silent MRI infarcts and the risk of future stroke: The cardiovascular health study. Neurology 2001; 57: 1222-1229
• 37 Kalaria RN. Vascular basis for brain degeneration: faltering controls and risk factors for dementia. Nutr Rev 2010; 68: S74-87
• 38 Beauchet O, Celle S, Roche F et al. Blood pressure levels and brain volume reduction: a systematic review and meta-analysis. J Hypertens 2013; 31: 1502-1516
• 39 Skoog I, Lernfelt B, Landahl S et al. A 15-year longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141-1145
• 40 Stewart R, Xue QL, Masaki K et al. Change in blood pressure and incident dementia: a 32-year prospective study. Hypertension 2009; 54: 233-240
• 41 Kilander L, Nyman H, Boberg M et al. Hypertension is related to cognitive impairment: A 20-year follow-up of 999 men. Hypertension 1998; 31: 780-786
• 42 Sharp SI, Aarsland D, Day S et al. Hypertension is a potential risk factor for vascular dementia: systematic review. Int J Geriatr Psychiatry 2011; 26: 661-669
• 43 Ross GW, Petrovitch H, White LR et al. Characterization of risk factors for vascular dementia: the Honolulu-Asia Aging Study. Neurology 1999; 53: 337-343
• 44 Ueda K, Kawano H, Hasuo Y et al. Prevalence and etiology of dementia in a Japanese community. Stroke 1992; 23: 798-803
• 45 Yoshitake T, Kiyohara Y, Kato I et al. Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: the Hisayama Study. Neurology 1995; 45: 1161-1168
• 46 Prince M, Albanese E, Guerchet M. World Alzheimer Report 2014. Dementia and risk reduction. An analysis of protective and modifiable factors. London: Alzheimer’s Disease International (ADI); 2014
• 47 Power MC, Weuve J, Gagne JJ et al. The association between blood pressure and incident Alzheimer disease: a systematic review and meta-analysis. Epidemiology 2011; 22: 646-659
• 48 Meng XF, Yu JT, Wang HF et al. Midlife vascular risk factors and the risk of Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis 2014; 42: 1295-1310
• 49 Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 2011; 10: 819-828
• 50 Norton S, Matthews FE, Barnes DE et al. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 2014; 13: 788-794
• 51 Kivipelto M, Helkala EL, Laakso MP et al. Midlife vascular risk factors and Alzheimer’s disease in later life: longitudinal, population based study. BMJ 2001; 322: 1447-1451
• 52 Wu C, Zhou D, Wen C et al. Relationship between blood pressure and Alzheimer‘s disease in Linxian County, China. Life Sci 2003; 72: 1125-1133
• 53 Whitmer RA, Sidney S, Selby J et al. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology 2005; 64: 277-281
• 54 Ninomiya T, Ohara T, Hirakawa Y et al. Midlife and late-life blood pressure and dementia in Japanese elderly: the Hisayama study. Hypertension 2011; 58: 22-28
• 55 Corrada M, Hayden KM, Bullain SS et al. Age of onset of hypertension and risk of dementia in the oldest-old: The 90+ Study. Alzheimers Dement 2014; 10: P501
• 56 McGuinness B, Todd S, Passmore P et al. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev 2009; 4 CD004034
• 57 Forette F, Seux M-L, Staessen JA et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352: 1347-1351
• 58 Forette F, Seux ML, Staessen JA et al. The prevention of dementia with antihypertensive treatment. New evidence from the systolic hypertension in Europe (Syst-Eur) Study. Arch Int Med 2002; 162: 2046-2052
• 59 Tzourio C, Anderson C, Chapman N et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 2003; 163: 1069-1075
• 60 Haag MDM, Hofman A, Koudstaal PJ et al. Duration of antihypertensive drug use and risk of dementia. A prospective cohort study. Neurology 2009; 72: 1727-1734
• 61 Stewart R, Xue QL, Masaki K et al. Change in blood pressure and incident dementia a 32-year prospective study. Hypertension 2009; 54: 233-240
• 62 Peila R, White LR, Masaki K et al. Reducing the risk of dementia. Efficacy of long-term treatment of hypertension. Stroke 2006; 37: 1165-1170
• 63 Sugiyama T, Lee JD, Shimizu H et al. Influence of treated blood pressure on progression of silent cerebral infarction. J Hypertens 1999; 17: 679-684
• 64 Zanchetti A, Liu L, Mancia G et al. Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension – Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial. J Hypertens 2014; 32: 1888-1897
• 65 Böhm M, Schumacher H, Leong D et al. Systolic blood pressure variation and mean heart rate is associated withcognitive dysfunction in patients with high cardiovascular risk. Hypertension 2015; 65: 651-661
• 66 Lehrl S, Gräßel E, Eicke C. Wirkung von Felodipin bei hypertonen Patienten mit leichten Hirnleistungsstörungen in einer randomisierten Doppelblindstudie. Dtsch med Wochenschr 2000; 125: 1350-1356
• 67 Tedesco MA, Ratti G, Mennella S et al. Comparison of losartan and hydrochlorothiazide on cognitive function and quality of life in hypertensive patients. Am J Hypertension 1999; 12: 1130-1134
• 68 Duron E, Rigaud AS, Dubail D et al. Effects of Antihypertensive Therapy on Cognitive Decline in Alzheimer’s Disease. Am J Hypertens 2009; 22: 1020-1024
• 69 Peters R, Beckett N, Forette F et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol 2008; 7: 683-689
• 70 Van der Wardt V, Logan P, Conroy S et al. Antihypertensive treatment in people with dementia. J Am Med Dir Assoc 2014; 15: 620-629
• 71 Beishon LC, Harrison JK, Harwood RH et al. The evidence for treating hypertension in older people with dementia: a systematic review. J Hum Hypertens 2014; 28: 283-287
• 72 Ohrui T, Tomita N, Sato-Nakagawa T et al. Effects of brain-penetrating ACE inhibitors on Alzheimer disease progression. Neurology 2004; 63: 1324-1325
• 73 Kaiser EA, Lotze U, Schäfer HH. Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?. Clin Interven Aging 2014; 9: 459-475
• 74 Inaba S, Iwai M, Furuno M et al. Continuous activation of renin-angiotensin system impairs cognitive function in renin / angiotensinogen transgenic mice. Hypertension 2009; 53: 356
• 75 Wright JW, Harding JW. The angiotensin AT4 receptor subtype as a target for the treatment of memory dysfunction associated with Alzheimer’s disease. JRAAS 2008; 9: 226-237
• 76 Xie W, Zhu D, Ji L et al. Angiotensin-(1–7) improves cognitive function in rats with chronic cerebral hypoperfusion. Brain Res 2014; 1573: 44-53
• 77 Sink KM, Leng X, Williamson J et al. Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension. Arch Intern Med 2009; 169: 1195-1202
• 78 Chiu WC, Ho WC, Lin MH et al. Angiotension receptor blockers reduce the risk of dementia. J Hypertens 2014; 32: 938-947
• 79 Fogari R, Preti P, Mugellini A et al. Influence of losartan and atenolol on cognitive function in very elderly hypertensive patients. Am J Hypertens 2002; 15: 36A
• 80 Levi Marpillat N, Macquin-Mavier I, Tropeano AI et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 2013; 31: 1073-1082
• 81 Schrader J, Lüders S, Kulschewski A et al. Morbidity and mortality after stroke, Eprosartan compared with Nitrendipine for secondary prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005; 36: 1218-1226
• 82 Gelber RP, Ross GW, Petrovich H et al. Antihypertensive medication use and risk of cognitive impairment: The Honolulu-Asia Aging Study. Neurology 2013; 81: 888-895