Blood pressure reduction and risk of dementia in patients with stroke: rationale of the dementia assessment in PROGRESS (Perindopril Protection Against Recurrent Stroke Study). PROGRESS Management Committee.
High blood pressure is a known risk factor for multi-infarct dementia, a subtype of dementia caused by the occurrence of several strokes. However, this form of dementia is relatively uncommon and the influence of blood pressure on the risk of other subtypes of vascular dementia remains to be clarified. Furthermore, recent studies have suggested that vascular risk factors could also play a part in Alzheimer's disease. One of the aims of Perindopril Protection Against Recurrent Stroke Study (PROGRESS) is to test the hypothesis that blood pressure decreasing treatment based on perindopril would reduce the incidence of dementia among patients with cerebrovascular disease. The dementia procedures in PROGRESS involve a classical two-phase design, with an initial screening phase based mainly on the Mini-Mental State Examination - a simple, brief, and widely used screening test for dementia. The second phase involves a diagnostic assessment for dementia in individuals screened as positive according to the criteria of the American Psychiatric Association's Diagnostic and statistical manual of mental disorders (4th ed.). In this project, two other domains of the relationship between vascular risk factors and cognition are being explored in relation to PROGRESS substudies. The apolipoprotein E polymorphism, a genetic risk factor for Alzheimer's disease, is being determined in each patient, as part of the genetic substudy. This will allow study of the relationship between this polymorphism and blood pressure, and of the effect of blood pressure decreasing treatment on the risk of dementia. The magnetic resistance imaging substudy will improve understanding of the relationship between blood pressure decreasing and the occurrence of cerebral white matter lesions, which are known to be related to cognitive decline and dementia.
INSERM U360, Hôpital Salpêtrière, Paris, France.
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Tzourio
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Anderson
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003704:Dementia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril