• Lucy Y Wang, Eric B Larson, Joshua A Sonnen, Jane B Shofer, Wayne McCormick, James D Bowen, Thomas J Montine, and Ge Li.
• Mental Illness Research and Education Clinical Center, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington 98108, USA. wanglucy@u.washington.edu
• J Am Geriatr Soc. 2009 Nov 1; 57 (11): 1975-81.

ObjectivesTo examine correlations between blood pressure (BP) and dementia-related pathological brain changes in a community-based autopsy sample.DesignProspective cohort study.SettingA large health maintenance organization in Seattle, Washington.ParticipantsA cohort of 250 participants aged 65 and older and cognitively normal at time of enrollment in the Adult Changes in Thought (ACT) Study and who underwent autopsy.MeasurementsBP and history of antihypertensive treatment were taken at enrollment. A linear regression model was used to examine the relationship between BP (systolic (SBP) and diastolic (DBP)) at enrollment and pathological changes in the cerebrum (cystic macroscopic infarcts, microinfarcts, neuritic plaques, neurofibrillary tangles, and cortical Lewy bodies).ResultsThe presence of more than 2 microinfarcts, but not any other pathological change, was independently associated with SBP in younger participants (65-80, n=137) but not in older participants (>80, n=91). The relative risk (RR) for more than two microinfarcts with each 10-mmHg increase in SBP was 1.15 (95% confidence interval (CI)=1.00-1.33) in the younger participants, adjusted for age at entry, sex, and time to death. This RR was particularly strong in younger participants not taking antihypertensive medications (RR=1.48, 95% CI=1.21, 1.81); significant associations were not observed in participants treated for hypertension. Findings for DBP were negative.ConclusionThe association between high SBP and cerebrovascular damage in untreated older adults (65-80) suggests that adequate hypertension treatment may reduce dementia risk by minimizing microvascular injury to cerebrum.

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