Dementia is arguably the most pressing health care problem, costing more than stroke, cancer and heart disease combined1. With the observed increase in global population ageing, the incidence of dementia is forecast to treble over the next thrity years1. One of the best potential preventative methods against dementia to emerge is the detection and control of blood pressure abnormalities.
The Irish Longitudinal Study on Ageing (TILDA) is a study of over 8,000 people in Ireland aged 50 and over, charting health, economic and social circumstances to understand the determinants of ageing, early identifiers of the process, inform policy and track the effectiveness of policy change and interventions. TILDA has prioritised measures of neurocardiovascular stability and brain ageing, in particular, orthostatic blood pressure, autonomic function, and detailed cognitive function measures.
Though mid life hypertension is known to accelerate cognitive decline and dementia, hypotensive problems may be even more damaging. Preliminary TILDA data confirms that hypotension and autonomic impairment are strongly associated with abnormal global and domain specific cognitive function. TILDA is a unique opportunity to better understand the complexity of relationships among these variables by coupling TILDA objective health data with neuroimaging of a large subsample of its participants. By identifying which aspects of impaired blood pressure control are particularly linked with damage to the brain, then clear, feasible and scalable public health and clinical practice guidelines would emerge.
We propose to couple TILDA data with neuroimaging to study white matter hyperintensities, cerebral blood flow and vascular reactivity in a subset of 600 TILDA participants over 65. These brain imaging measures will further be used to predict longitudinal changes in cognitive and daily life function over subsequent TILDA follow-ups. Understanding these relationships will guide future treatment for both hypotension and hypertension and thus possibly contribute significantly to the prevention of dementia.
