Stroke, clogged arteries and atherosclerosis
Hardening of the Arteries Linked to Alzheimer's
A new study shows early plaque build-up in the brain scans of elderly people who have stiff arteries.
By Jennifer J. Brown, PhD
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WEDNESDAY, October 16, 2013 —A healthy heart leads to a healthy brain, and now researchers find that checking both the pulse and brain scans reveals a new connection. Arterial stiffness is closely linked to early characteristic brain plaques of Alzheimer's disease.
Authors of a new study published today in the journal Neurology report that brain scans of people with hardening of the arteries reveal the hallmark build-up of plaques found in Alzheimer’s disease.
When an older person has memory lapses, difficulty finding the right words, disorientation and confusion, these symptoms may point to Alzheimer's. What they can’t show are the hidden, underlying causes of the dementia. The most certain way to know if it’s Alzheimer’s is to do a brain scan to look for changes in the brain that reflect more than just normal aging.
Researcher Timothy M. Hughes, PhD, and others at Wake Forest School of Medicine and the University of Pittsburgh, studied the pulse and brain scans of 91 people between 83 and 96 years old who did not yet have any symptoms of dementia. The investigators found that half of these participants already had beta-amyloid plaques in their brain tissue at this early, pre-symptomatic stage.
The surprise finding was that patients with increased stiffness in their arteries were two to four times more likely to have visible plaque on their brain scans — demonstrating a link between hardening of the arteries and brain health.
A second brain marker that researchers found in people with hardened arteries was so-called white matter hyperintensity. This is a type of brain lesion that indicates subclinical cerebrovascular disease — patients aren't showing signs or symptoms. White matter hyperintensity is linked to an increased risk of stroke, dementia and death. Together with plaques may signal a “double hit” to the brain on the way to Alzheimer's disease, according to the research team.
Stiff Arteries and Alzheimer’s
“Arterial stiffness often occurs due to longstanding high blood pressure," explained cardiologist T. Jared Bunch, MD. Dr. Bunch said that the linings of the blood vessels have elastic fibers that allow the arteries to quickly accept blood and then transport it to the downstream organs. “With high blood pressure, these elastic fibers break down and the arteries become stiff like a pipe,” he added. Bunch is Medical Director of Electrophysiology at the Intermountain Heart Institute in Murray, Utah.
Increased stiffness of the arteries means that less oxygen and fewer nutrients reach brain cells. It also means that the beta-amyloid that collects in plaques can build up, but not be efficiently cleared from the brain by blood circulation — which may lead to Alzheimer’s.
According to Bunch, "Arterial stiffness is very common in older patients. In the general community, 30 to 40 percent of people will have some degree of high blood pressure.” He also said that if the blood pressure is not treated aggressively very early in life — with medications, lifestyle changes, weight loss, and dietary measures — then arterial stiffness develops.
But is blood pressure treatment enough? Not according to the lead researcher in the new study, Dr. Hughes.
“Arterial stiffness is the driving force behind hypertension’s effects on the brain,” said Hughes. “Current anti-hypertensive treatments target lowering blood pressure, but they have little to no effect on reversing arterial stiffness.”
As Hughes explained, “Our arteries continue to harden as we age and elevated blood pressure accelerates this stiffening.” He added that future research “should consider targeting stiffness — over blood pressure — in order to reverse arterial stiffness and protect end organs like the brain.”
“Right now," Hughes added, "the most promising line of research shows that targeting cardiometabolic risk factors — like obesity and insulin resistance — with physical activity and weight loss has a direct and powerful impact on arterial stiffness."
Alzheimer’s in Perspective
Alzheimer's disease is the most common cause of dementia and has become the sixth leading cause of death in the United States, according to the U.S. Centers for Disease Control and Prevention. Alzheimer’s affects an estimated 5.4 million Americans already, and the number of people with Alzheimer’s had increased dramatically over the last 10 years — by about 40 percent.
Age matters: For people 85 and older the risk of dying from Alzheimer’s disease is five times higher than for people 75 to 84.
“The Alzheimer's diseases research community is coming to the realization that targeting amyloid plaques may be too late in the disease process," said Hughes.
The time to take steps to prevent Alzheimer’s is in middle age. “We have known for a while that mid-life hypertension is a strong risk factor for the development of dementia," said Hughes. "Finding that modifiable risk factors like hypertension/arterial stiffness are closely related to amyloid deposition in the brain — in addition to cerebrovascular disease — is potentially very important for the prevention of amyloid accumulation and dementia.”
The new link between heart health and brain health may lead to a better understanding of how to prevent Alzheimer’s.
YOUR VIEWS:Do you have a family member or friend who is struggling with Alzheimer’s? Please add your comments and share your views.
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