Dementia is now the commonest cause of death in the UK and is a major cause of morbidity. By 2020 there will be at least 850,000 patients living with dementia in the UK, with huge impact on families and carers. The economic impact is daunting and estimated to be at least 60 billion per year to the economy. There is therefore a great need to find better ways to detect dementia early and to try to delay its progress and ultimately find a cure. The UK government and charities have recently invested £250m to establish a UK Dementia Research Institute which is lead from UCL.
Patients with dementia experience a slowly progressive loss of cognitive functions and ultimately become completely dependent on others for all care. Alzheimer's disease is the major cause of dementia and is characterised by progressive loss of cortical neurones (brain cells) probably because of the accumulation of abnormal proteins which are toxic and cases neuronal death. The second major cause is vascular disease in which there is a progressive "hardening" and "narrowing" of small arteries in the brain resulting in reduced blood flow and ultimately neuronal death. It is recognised that high blood pressure, high cholesterol and a sedentary life style are risk factors for vascular dementia. Any research that finds methods that might be able to predict dementia is important as it might provide the opportunity to intervene early.
In this research an international team of experts, led by University College London (UCL), measured the intensity of the pulse travelling towards the brain in 3,191 people in 2002 and monitored them over the next 15 years in a cohort of patients known as the Whitehall study. Over the next 15 years, researchers monitored participants' memory and problem-solving ability by undertaking a battery of memory tests. Those with the highest intensity pulse (the top quarter of participants) at the beginning of the study were about 50% more likely to show accelerated cognitive decline over the next decade compared with the rest of the participants, the study found. Researchers said this was the equivalent of about an extra one to one-and-half years of decline.
They postulate that this stronger "pulse wave" that they detected in the neck would be transmitted to the smaller arteries of the brain and over long periods of time (years) this pressure would damage the small arteries and cause them to harden and narrow and cause reduced blood flow and potentially neuronal loss.
Professor Michael Hanna, Consultant Neurologist commented:
"Although this is an interesting study that makes a link between the "pulse wave" which can be measured using neck ultrasound and cognitive decline there are some important limitations which means further research is now needed.
First, the measurement of cognitive decline was not correlated with MRI brain scans to assess if there were changes in blood vessels or structures in the brain and researchers next plan to use MRI scans to check if people in the study also display structural and functional changes within the brain that may explain their cognitive decline.
Second, a small decline in cognitive function does not mean the patients had dementia and it is not the case that all patients who experience this degree of cognitive decline are destined to develop dementia. The researchers therefore need to identify patients in their cohort who have been diagnosed with definite dementia based on detailed cognitive testing and MRI scans and compare the pulse pressure wave in this group with the pulse pressure in an age matched non-dementia group. They plan to do this.
Based on this study data there is not yet a role for pulse wave measurements in clinical practice to predict dementia.
What is already known is that all patients should ensure they have their blood pressure and cholesterol controlled and they engage in regular aerobic activity each week and maintain a healthy weight."
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