Hanon Olivier
Université Paris Descartes, service de gériatrie, hôpital Broca, AP-HP, 75013, Paris.
Rev Prat. 2010 May 20;60(5):649-53.
Prevention and treatment of dementia has turned into a major public health challenge. Recent epidemiological studies have shown a significant association between the presence of hypertension and the occurrence of cognitive decline or dementia (including Alzheimer's disease). Indeed, the summation of vascular brain damage and degenerative changes may contribute to an early expression of a still subclinical Alzheimer's disease, causing the threshold of dementia to be reached earlier. Some recent randomized controlled trials (SYST-EUR, PROGRESS, HOPE, SCOPE, HYVET) included cognition as secondary endpoint. Their results open the way for prevention of dementia by antihypertensive treatments. It is therefore necessary that further randomized trials are conducted with the primary objective to assess the impact of antihypertensive treatment on cognitive decline or dementia. In clinical practice, it is important to identify, among hypertensive patients, the subjects at risk for dementia, i.e those who already have mild cognitive impairment or extensive cerebral white matter lesions, in order to optimize blood pressure control and monitor cognitive function (regular cognitive assessment, drugs adherence).
痴呆症的预防和治疗已成为一项重大的公共卫生挑战。最近的流行病学研究表明，高血压的存在与认知能力下降或痴呆症（包括阿尔茨海默病）的发生之间存在显著关联。事实上，血管性脑损伤和退行性变化的总和可能导致仍处于亚临床阶段的阿尔茨海默病早期表现，使痴呆症的阈值提前达到。最近的一些随机对照试验（SYST-EUR、PROGRESS、HOPE、SCOPE、HYVET）将认知作为次要终点。它们的结果为通过抗高血压治疗预防痴呆症开辟了道路。因此，有必要进行进一步的随机试验，其主要目的是评估抗高血压治疗对认知能力下降或痴呆症的影响。在临床实践中，重要的是在高血压患者中识别出有痴呆症风险的受试者，即那些已经有轻度认知障碍或广泛脑白质病变的患者，以便优化血压控制并监测认知功能（定期进行认知评估、药物依从性）。
