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Hypertension and Diabetes Can Affect Thinking Skills

A recent study has shed some light on the role that high blood pressure, diabetes and smoking can play in mid-life cognitive decline. But these are modifiable risk factors. The study was published in the online issue of Neurology, the medical journal of the American Academy of Neurology.

“Cardiovascular risk factors, especially high blood pressure and diabetes, become more common in midlife. We found those two risk factors, as well as smoking, are associated with higher odds of having accelerated cognitive decline, even over just a short span of five years,” said study author Kristine Yaffe, MD, of the University of California, San Francisco, professor of psychiatry, neurology and epidemiology and the director of the Center for Population Brain Health at the university. A member of the American Academy of Neurology, she added, “In other words, people with these risk factors had a greater chance of having faster cognitive decline than a group of their peers who did not smoke or have high blood pressure or diabetes. It’s encouraging to know that there are behaviors people can modify in midlife to help prevent the steepest declines in thinking and memory as they age.”

The study involved 2,675 participants with an average age of 50 who did not have dementia. Researchers measured their cardiovascular risk factors at the outset of the study. Statistics indicated that 43% were considered obese, 31% had high blood pressure, 15% were smokers, 11% had diabetes, and 9% had high cholesterol. Participants were given thinking and memory tests at the beginning of the study, as well as five years later. Researchers then estimated the association of the five cardiovascular risk factors with the decline in the performance on thinking and memory tests that was not defined as dementia, but showed faster decline than that seen in a group of adults of similar ages.

Researchers noted that 5% of participants had accelerated cognitive decline over five years. A total of 7.5% of those with high blood pressure experienced faster decline compared with 4.3% of those who did not have high blood pressure. Additionally, 10.3% of those with diabetes experienced faster decline compared with 4.7% of those who did not have diabetes. A total of 7.7% of current smokers had faster decline compared with 4.3% of those who never smoked.

Researchers found that after adjusting for age, race, education and other factors that could affect the risk of cognitive decline, those with high blood pressure were 87% more likely and those with diabetes were nearly three times as likely to have accelerated cognitive decline. “Surprisingly, people who were considered obese and those with high cholesterol did not have a greater risk of cognitive decline,” Yaffe said. “Other studies have shown a link between obesity and dementia, but mostly in older adults. Meanwhile, the studies that examine high cholesterol and dementia have had mixed results, so our research adds to those studies.

People who had one or two of the risk factors were nearly twice as likely to have accelerated decline than people with no risk factors. People with three or more of the risk factors were nearly three times as likely to experience faster cognitive decline than those with no risk factors. Of the 1,381 people with one or two risk factors, 71 experienced faster decline, or 5.1%, compared with 19 of the 700 people with no risk factors, or 2.7%, and 53 of the 594 people with three or more risk factors, which is 8.9%.

“Most public health prevention efforts focus on older adults, but our study suggests the need to look at cognitive performance across a person’s life span,” Yaffe said. “Middle-aged adults who have one or more cardiovascular risk factors like smoking, high blood pressure and diabetes may be people we should be monitoring and educating on healthy lifestyle choices earlier in life.”

With the important consequences that may hang in the balance, it’s critical to make judicious lifestyle choices and take steps to change lifestyle practices that result in conditions that can possibly affect future cognition. Discuss these choices and possibilities with your provider for recommendations that can improve your odds of avoiding dementia.

Ithaca Primary Care

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