Blood pressure and neuropsychiatric symptoms in old age

Moonen, J.E.F. (2017)

Doctoral Thesis

The overriding aim of my thesis was to study the relationship between blood pressure (BP) and cognitive and psychological functioning in older persons. Observational studies indicate that lower BP increases risk for cognitive decline in older persons. Older persons are at risk for impaired cerebral autoregulation, and lowering their BP may compromise cerebral blood flow and cognitive function. Contradictory to our hypothesis, the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study Leiden, a community-based randomized clinical trial in older persons (aged ≥75 years) with mild cognitive deficits, did not show that discontinuation of antihypertensive treatment improves cognitive functioning. The lack of the effect of this trial may be due to the unintentional inclusion of persons with a relatively intact cerebral autoregulation. Furthermore, we demonstrated that older persons with mild cognitive deficits and with orthostatic hypotension, who discontinued all their antihypertensive medication had an increased probability of being free from orthostatic hypotension 4 months later, compared to persons who continued their medication. Finally, in the DANTE MRI sub study, the relationship between BP and both conventional features of small vessel disease (SVD) and microstructural damage was explored, as well as the relation between microstructural damage and cognitive and psychological dysfunction.

• Cognition
• Depression
• Apathy
• Blood pressure
• Elderly
• Trial
• Antihypertensive treatment

• All authors: Moonen, J.E.F.
• Supervisor: Mast, R.C. van der
• Co-supervisor: Ruijter, W. de; Craen, A.J.M. de
• Committee: Achterberg, W.P.; Muller, M.; Stek, M.L.; Gool, W.A. van
• Qualification: Doctor (dr.)
• Awarding Institution: Medicine, Leiden University
• Date: 2017-04-11
• ISBN (print): 9789463321228
• Sponsorship: The Dutch Heart Foundation, Alzheimer Nederland, Chipsoft