Brain Damage From Chronic Hypertension Studied

Daniela Carnevale, PhD, Researcher Laboratory of Giuseppe Lembo, MD, PhD Dept. of Molecular Medicine "Sapienza" University of Rome & Dept. of Angiocardioneurology and Translational Medicine IRCCS Neuromed - Technology Park Località Interview with:
Daniela Carnevale, PhD, Researcher
Laboratory of Giuseppe Lembo, MD, PhD
Dept. of Molecular Medicine
“Sapienza” University of Rome
& Dept. of Angiocardioneurology and Translational Medicine
IRCCS Neuromed – Technology Park
Località Camerelle

Medical Research: What is the background for this study?

Dr. Carnevale: Nowadays, one of the most demanding challenge in medicine is preserving cognitive functions during aging. It is well known that cardiovascular risk factors have a profound impact on the possibility of developing dementia with aging. However, we have no means to investigate this aspect in patients with cardiovascular diseases. Indeed, although we have clear clinical paradigms to explore target organ damage of vascular diseases like hypertension, we are less prepared to afford the brain damage that may result from chronic vascular diseases and impact on cognitive functions. Thus, we aimed at finding a diagnostic paradigm to assess brain damage that could predict for future development of dementia. Since it is becoming increasingly clear that hypertension may determine cognitive decline, even before manifest neurodegeneration, we elaborated a paradigm of analysis that are essentially focused on brain imaging and cognitive assessment. In particular, we used diffusion tensor imaging (DTI) on magnetic resonance that allows to reconstruct white matter connections that correlate with selective cognitive functions, and specifics tests for the evaluation of subtle alterations of cognitive functions.

Medical Research: What are the main findings?

Dr. Carnevale: The main findings of our research are:

– Identification of a pattern of white matter alterations evidenced by tractography MRI typical of hypertensive patients

– Correlation of brain imaging with specific functional tests for cognitive assessment

– Correlation of all these alterations with typical clinical parameters used in hypertensive patients for the evaluation of target organ damage

– Altogether we can define a clinical approach to evaluate pre-symptomatic brain damage in hypertensive patients which could be applied to largest populations of patients, in order to identify possible therapeutic regimens that could be more valuable in the management of patients suffering from initial signs of vascular cognitive impairment.

Medical Research: What should clinicians and patients take away from your report?

Dr. Carnevale: We suggest to clinicians to start considering the potential brain damage in the clinical approach to hypertensive patients. It could be important to have an early videat of brain imaging and cognitive assessment in order to monitor the eventual development of dementia. Basically, it could be considered that this technology is already present in clinical practice. Indeed, the brain scanning is performed with high magnetic field MRI, by adopting specific sequences of acquisition. Although this kind of brain scanning is not performed in the routine clinical practice, it should be considered that this is a completely non invasive examination. However, the most challenging aspect of this technique is data reconstruction and analysis, together with cognitive assessment and clinical evaluations, implying the need of a multidisciplinary team that encloses clinicians, biologists, informatics engineers and radiologists.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Carnevale: We think that we are at the beginning of a novel way to approach to vascular cognitive impairment in hypertensive patients. It is generally recognized that people with chronic hypertension more frequently become demented. However, it is still unknown how to protect brain in hypertensive patients, in order to hamper the progression of cognitive impairment and brain damage. In our study we have assessed this paradigm of brain alterations in hypertensive patients already in therapy and with good control of blood pressure. However, this does not imply that medications have no efficacy. Our idea is that we should still find an adequate treatment regimen for people at risk of develop cognitive dysfunction. Indeed, if we think to other signs of target organ damage in hypertension (like cardiac remodeling or chronic kidney disease), it is generally accepted that not all the available medications and therapeutic regimens have the same impact on different kinds of organ damage. Thus, it is conceivable that also the brain may need a specific therapeutic regimen and that different medications with different mechanisms of action could have different impact on cognitive functions in hypertensive patients. Moreover, we think that, by defining this diagnostic paradigm, patients could benefit of a periodic control of brain damage (this is already routinely applied for other organ damages in hypertension). We are now going on with this research, in order to understand these next steps (effects of therapy and follow-up).


Council on Hypertension 2015 Scientific Sessions

Tractography of White Matter Connections Predicts for Vascular Cognitive Impairment in Hypertensive Patients Lorenzo Carnevale, Giulio Selvetella, Daniela Cugino, Giovanni Grillea, IRCCS Neuromed, Pozzilli (IS), Italy; Giuseppe Lembo, Daniela Carnevale, Sapienza Univ of Rome at IRCCS Neuromed, Pozzilli (IS), Italy

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Daniela Carnevale, PhD (2015). Brain Damage From Chronic Hypertension Studied