Clinical Trials of Anti-Hypertensive Medication for MCI ...课件.ppt

Speaker Name Clinical Trials of Anti-Hypertensive Medication for MCI and dementia Ingmar Skoog, M.D., Ph.D. Institute of Neuroscience and Physiology Unit of Neuropsychiatric Epidemiology Sahlgrenska Academy at G?teborg University G?teborg, Sweden DISCLOSURES Consultant: AstraZeneca for the SCOPE trial Speakers Bureau: Esai, JansenCilag, AstraZeneca, Shire, Pfizer, Novartis Background Prevalence of hypertension increases with age More than 50% of elderly populations have hypertension with current criteria (140/90) An emerging problem in the developing world End-organ damage The arterial tree Heart Kidney Brain Eyes HYPERTENSION IN RELATION TO COGNITION Hypertension Stroke White Matter Lesions Cognitive impairment Hypertension and the brain Cerebral autoregulation Blood brain barrier dysfunction Decreased cerebral blood floow Stroke (hemorrhagic, ischemic) White matter lesions Dementia and Alzheimer’s disease RISK OF DEMENTIA IN RELATION TO STROKE70+ G?teborg Cognitive impairment in non-demented stroke patients70+ G?teborg SILENT INFARCTS The frequency of silent infarcts on MRI increases with age (Vermeer et al, Stroke 2003) Increases the incidence of dementia (HR 2.3 (95-% CI 1.1-4.7) during 3.6 years follow-up Related to worse performance on psychometric testing at baseline Increases risk of clinical stroke on follow-up (Vermeer et al. N Engl J Med 2003) RISK OF DEMENTIA IN RELATION TO INFARCTS ON CT AND HISTORY OF STROKE AT AGE 85 H-70 STUDY, G?TEBORG, SWEDEN Hypertension and the brain Cerebral autoregulation Blood brain barrier dysfunction Decreased cerebral blood floow Stroke (hemorrhagic, ischemic) White matter lesions Dementia and Alzheimer’s disease WHITE MATTER LESIONS IN RELATION TO DEMENTIA IN 85-YEAR-OLDS % No dementia 34 Alzheimer′s disease 64** Vascular dementia 70*** Other dementias 80* Cognitive function in non-demented 85-year-olds in relation to white matter lesions Hypertension and the brain Cerebral auto