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From the Institute of Clinical Neuroscience, Department of Psychiatry,
Sahlgrenska University Hospital (I.S.), the Department of Geriatric Medicine,
Vasa Hospital (S.L., B.L.), Göteborg University, and the Department of
Radiology, Östra Hospital (L.-A.A.), Göteborg, Sweden.
Correspondence to Ingmar Skoog, MD, PhD, Department of Psychiatry, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. E-mail Ingmar.Skoog{at}psychiat.gu.se
Abstract—In the general population,
mean systolic and diastolic blood pressure
increases up to age 75 years but decreases thereafter. The brain has a
role in blood pressure regulation; it is not clear whether the cerebral
changes that occur with aging contribute to the decline in blood
pressure in the very elderly. We examined a population-based sample of
484 85-year-old persons (344 nondemented and 140 demented, 61 with
Alzheimer's disease, 65 with vascular dementia, and 14 with
other types of dementia) with a neuropsychiatric examination and blood
pressure measurements. Dementia was diagnosed according to the criteria
proposed in the Diagnostic and Statistical Manual of
Mental Disorders, edition 3, revised. Brain atrophy was
measured by CT of the brain. In the nondemented group, frontal
(r=-0.18, P=0.037) and parietal
(r=-0.23, P=0.008) cortical atrophy and
bifrontal ratio (r=-0.20, P=0.013) were
associated with lower systolic blood pressure, and frontal
(r=-0.23, P=0.010) and parietal
(r=-0.24, P=0.008) cortical atrophy and
bifrontal ratio (r=-0.23, P=0.006) with
lower diastolic blood pressure. Systolic blood
pressure was lower in subjects with Alzheimer's disease and
vascular dementia, and diastolic blood pressure was lower
in those with vascular dementia compared with the nondemented.
Systolic (r=-0.27, P<0.0001)
and diastolic (r=-0.10,
P=0.020) blood pressure was negatively correlated to
dementia severity. In the demented subjects, frontal cortical atrophy
was correlated to lower diastolic blood pressure
(r=-0.21, P=0.043). Our findings suggest
that age-related changes in brain structure may contribute to the
decrease in blood pressure in the very elderly and that low blood
pressure in dementia disorders is mainly a secondary phenomenon.
© 1998 American Heart Association, Inc.
Scientific Contributions
A Population-Based Study on Blood Pressure and Brain Atrophy in 85-Year-Olds
Key Words: blood pressure • cerebral atrophy • epidemiological methods • Alzheimer's disease • dementia, vascular
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