Ageing Brain and Cognition/Circulation (ABC)

Ageing Brain and Cognition/Circulation pipeline

Focus

The focus of this pipeline is on brain research with a strong link to aging, cognition and circulation. Research topics within this pipeline are dementia, cerebral small vessel disease, glymphatic imaging and the heart-brain connection.

Studies

Imaging studies

Ongoing clinical studies within this pipeline are the heart-brain connection study, the WHIMAS study, the COPE study, the currently in preparation IMDEM study/trial and also includes collaborations with the AGES-Reykjavic consortium. This pipeline also has close links to the Medical Delta 2.0 dementia and stroke consortium and the new Medical Delta 3.0 Advanced imaging for diagnosis and prediction of dementia consortium (collaborations between LUMC, Erasmus MC and TU Delft; Medical Delta Programma ‘Geavanceerde beeldvorming voor diagnose en predictie van dementie’ | Medical Delta), which will leverage knowledge on new brain MRI technologies and brain MRI AI implementations for early risk assessment for cognitive decline and dementia. This pipeline involves collaborations between the departments of cardiology, general practice, geriatrics, nephrology, neurology, psychiatry, and radiology (alphabetic order).

Pre-clinical and post-mortem studies include animal models of dementia and cerebral small vessel disease and pathological hallmarks and biomarkers of aging, cognition and circulation.

Benefits and risks of high blood pressure in older people

The benefits and risks of high blood pressure in old age: challenging observational and interventional data.

Results of observational studies, in short

  • In the Leiden 85-plus Study, an observational population-based prospective follow-up study of the oldest old, we showed that a lower blood pressure predicts a higher mortality over 5 years. This is a contrasting finding compared to the adult population.
  • In indepth analyses in the Leiden 85-plus Study, we showed that the mortality risk, risk of decline in (cognitive) function and falling is highest in those with low blood pressure under anti-hypertensive treatment.
  • Similar observational relations were found in the TULIP-consortium, a collaboration of cohort studies of oldest old populations from United Kingdom, Japan and New Zealand.
  • In a systematic review of guidelines, we showed that starting treatment with antihypertensive medication varies over guidelines, as do the target values of treatment depending on age.
  • We showed that GPs advised differently about starting anti-hypertensive medication in older patients in absence of clear guidelines.

Results of intervention studies, in short

  • In the DANTE study (2015), a randomised controlled trial, we found that a 12 weeks deprescribing of antihypertensive medication in community-dwelling older persons with mild cognitive impairment did not improve quality of life or cognitive function.

In the DANTON study (2024), a randomised controlled trial, we found that an 18 weeks deprescribing of antihypertensive medication in older persons with dementia living in nursing homes did not improve neuropsychiatric symptoms and quality of life. In contrast, the risk of negative effects was higher in those who reduced their dose of anti-hypertensive medication. At 36 weeks, these effects continued.

Key references

Imaging studies

Blood pressure and cognition

Observational studies

Intervention studies