One of the most difficult parts of aging is cognitive decline. While not all of us experience problems with memory and concentration as we get older, these problems are more common than we would like, and can be devastating. Dementia is expensive, too. A study in the Annals of Internal Medicine reported that, in the last five years of life, total health care spending for people with dementia was more than a quarter-million dollars per person, some 57 percent greater than costs associated with death from other diseases, including cancer and heart disease.
As nurses, we have long known the relationship between vascular brain disease and cognitive decline. I remember my grandmother (who was born in 1890) referring to “hardening of the arteries” in the context of “forgetfulness”.
Yet, this concept, with some new details, has become a hot topic in public health. Research supports a correlation between midlife vascular risk factors and late-life cognitive outcomes. In January, 2019, the National Institute of Health (NIH) announced the results of phase 2 of the landmark SPRINT trial. Back in 2015, SPRINT informed us that blood pressure treatment to 120 mmHg (compared to 140 mmHg) resulted in significantly greater protection from major cardiovascular events. This year, the research team reported that this level of blood pressure control prevented mild cognitive decline (MCD) a known precursor to dementia.
There is more hope! In related announcement from NIH, The National Institute on Aging (NIA) has funded a major study to examine the overall benefits and risks statins in adults age 75 or older without cardiovascular disease. The trial will help determine whether a statin can help prevent dementia and disability in this age group, as well as heart attacks and other cardiovascular-related deaths, while not increasing risks of adverse health outcomes. Funding for the trial, called Pragmatic Evaluation of Events and Benefits of Lipid-Lowering in Older Adults (PREVENTABLE), is expected to total $90 million over the next seven years. (NIA is part of the National Institutes of Health).
Let’s keep this information in mind when caring for our patients, and teach them the importance of those 20 little millimeters of mercury to their futures. Working together, we have the tools to decrease the incidence of dementia. How cool is that?
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