A follow-up study of the Discontinuation of ANtihypertensive treatment in the Elderly (DANTE) study Leiden

High blood pressure at mid-life is a well-known risk factor for cognitive
decline in old age. Nevertheless, the effect of late-life blood pressure on
cognition remains ambiguous. Observational studies suggested that in old age a
lower rather than a higher blood pressure is associated with an increased risk
of cognitive decline .The DANTE Study Leiden, was a community-based randomized
controlled trial designed to explore whether discontinuation of
antihypertensive treatment for four months would improve cognitive and
psychological functioning. In the DANTE population (n=398) of older persons
aged 75 years and over, blood pressure as well as cognition, symptoms of
depression and apathy, general daily functioning and quality of life were
assessed at baseline and at four-month follow-up. The results of the DANTE
study Leiden indicated that discontinuation of antihypertensive treatment
indeed increased the blood pressure. However, the four-month discontinuation of
antihypertensive treatment did not improve cognitive, psychological, and
general daily functioning.

In a subset (n=220) of the DANTE population, MRI was performed at baseline.
These data showed that in persons with a relatively low BP, specific features
of neurodegeneration were present, such as increased subcortical atrophy and a
diminished microstructural integrity. On baseline, these changes were
cross-sectionally associated with a lower cognitive performance. Interestingly,
similar neurodegenerative changes, were predictive for a steeper decline in
cognitive ability in a slightly younger population (mean age 73y). The
hypothesis of the present research proposal is that older persons with a
relatively low blood pressure at baseline will show a steeper decline in
neurocognitive functioning at four-year follow up than persons with a
relatively high BP at baseline. We also think that certain MRI phenotypes,
including subcortical atrophy and a diminished microstructural integrity, are
predictive for a decline in cognitive functioning after four years.

To assess the association between baseline blood pressure and change in
neurocognitive functioning after four years, and to assess whether baseline MRI
phenotypes are predictive for changes in neurocognitive functioning after four
years in the DANTE population.

Observational follow-up study

Persons who wish to participate will receive a one-time home visit. Within a
maximum of 90 minutes the researcher will measure blood pressure and assess
neurocognitive functioning, general daily functioning and quality of life using
above mentioned tests and questionnaires. There are no risks associated with
participation in this study. The burden associated with participation is mostly
the demands on the subjects* time and energy.